Respiratory Motion Compensation for C-arm CT Liver Imaging - Sindel, Aline; Bögel, Marco; Maier, Andreas; Fahrig, Rebecca; Hornegger, Joachim; Dörfler, Arnd (Bildverarbeitung für die Medizin 2015, 2015)
UnivIS-Import:2015-04-17:Pub.2015.tech.IMMD.IMMD5.respir

Response to: 'Synovitis in knee osteoarthritis: a precursor or concomitant feature?' by Zeng et al - Atukorala, Inoshi; Kwoh, C. Kent; Guermazi, Ali; Roemer, Frank; Boudreau, Robert; Hannon, Michael J.; Hunter, David J. (Annals of the Rheumatic Diseases, 2015)
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Responsiveness of afferent renal nerve units in renovascular hypertension in rats - Rodionova, Kristina; Hilgers, Karl Friedrich; Rafii-Tabrizi, Salman; Doellner, Johannes; Cordasic, Nada; Linz, Peter; Karl, Annalena; Ott, Christian; Schmieder, Roland; Schiffer, Mario; Amann, Kerstin Ute; Veelken, Roland; et al. (Pflügers Archiv: European Journal of Physiology, 2021)
Previous data suggest that renal afferent nerve activity is increased in hypertension exerting sympathoexcitatory effects. Hence, we wanted to test the hypothesis that in renovascular hypertension, the activity of dorsal root ganglion (DRG) neurons with afferent projections from the kidneys is augmented depending on the degree of intrarenal inflammation. For comparison, a nonhypertensive model of mesangioproliferative nephritis was investigated. Renovascular hypertension (2-kidney, 1-clip [2K1C]) was induced by unilateral clipping of the left renal artery and mesangioproliferative glomerulonephritis (anti-Thy1.1) by IV injection of a 1.75-mg/kg BW OX-7 antibody. Neuronal labeling (dicarbocyanine dye [DiI]) in all rats allowed identification of renal afferent dorsal root ganglion (DRG) neurons. A current clamp was used to characterize neurons as tonic (sustained action potential [AP] firing) or phasic (1-4 AP) upon stimulation by current injection. All kidneys were investigated using standard morphological techniques. DRG neurons exhibited less often tonic response if in vivo axonal input from clipped kidneys was received (30.4% vs. 61.2% control, p < 0.05). However, if the nerves to the left clipped kidneys were cut 7 days prior to investigation, the number of tonic renal neurons completely recovered to well above control levels. Interestingly, electrophysiological properties of neurons that had in vivo axons from the right non-clipped kidneys were not distinguishable from controls. Renal DRG neurons from nephritic rats also showed less often tonic activity upon current injection (43.4% vs. 64.8% control, p < 0.05). Putative sympathoexcitatory and impaired sympathoinhibitory renal afferent nerve fibers probably contribute to increased sympathetic activity in 2K1C hypertension.
CRIS-Team WoS Importer:2021-07-23

Retinal microangiopathy in arterial hypertension as an early marker of a cerebral macroangiopathy - Michelson, Georg; Engelhorn, Tobias; Dörfler, Arnd (Deutsche Medizinische Wochenschrift, 2011)
A 54-year-old man reported having had nonspecific attacks of dizziness. His BMI was 27.7. Since 11 years he had been treated for arterial hypertension and had received oral medication for type 2 diabetes for one year. The latest blood pressure value was 134/109 mm Hg during treatment with a combination of atenolol, chlortalidone und hydralazine-HCl; furthermore hr received simvastatin, metformin, glimepirid und ramipril. A standardized telemedical imaging of the retina ("talkingeyes (®) ") was undertaken, revealing focal and generalized arteriolar narrowing of the retinal vessels and a retinal microinfarction (cotton wool spot) in the right eye. The arterial/venous ratio was decreased to 0.74 in the right and 0.77 in the left eye.Optical coherence tomographie (OCT) revealed an ischemic microinfarction of the retina with marked axonal swelling. The digital subtraction angiography of the cerebral vessels revealed a 40 % stenosis of the right internal carotid artery and a proximal, highgrade stenosis of the basilary artery.Angioplasty with stent insertion of the basilary artery was performed. Long-term observation showed no restenosis and a reduction in the size of the the retinal microinfarct.Retinal microinfarctions denote localized retinal areas of hypoxia and underperfusion. They may act as markers of a generalized micro- and macroangiopathy. Patients with severe retinal microangiopathic changes should be examined thoroughly to detect early macroangiopathic changes. These can be treated by interventional procedures thus avoiding irreversible end-organ damages.
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Retinal microperfusion after renal denervation in treatment-resistant hypertensive patients - Ott, Christian; Harazny, Joanna M.; Schmid, Axel; Ditting, Tilmann; Veelken, Roland; Bladowski, Marek; Michelson, Georg; Uder, Michael; Schmieder, Roland (Clinical Research in Cardiology, 2015)
High pulsatile pressure and flow in the arteries causes microvascular damage, and hence increased cardio-, and cerebrovascular complications. With advanced stages of hypertensive disease, an exaggerated pulsatile retinal capillary flow (RCF) has been shown, but data about interventional effect are missing.Fifty-one patients with true treatment-resistant hypertension (TRH) underwent renal denervation (RDN) using the Symplicity Flex(TM) catheter and were followed for 12 months. RCF was assessed non-invasively using Scanning laser Doppler flowmetry (SLDF) before, 6 (6 M), and 12 (12 M) months after RDN. RCF was measured in systole and diastole and pulsed RCF (difference of RCF in systole minus diastole) was calculated. In addition, flicker light-induced vasodilation (representing vasodilatory capacity) was assessed.Systolic and diastolic office blood pressure (BP) as well as 24-h ABPM decreased significantly 6 M and 12 M after RDN, compared to baseline values (all p < 0.001). There was a significant reduction of pulsed RCF 6 M (231 ± 81 versus 208 ± 68 AU, p = 0.046) and 12 M (194 ± 72 AU, p = 0.001) after RDN, whereas the mean RCF was unchanged. Moreover, there was a significant increase of flicker light-induced vasodilation after RDN (p = 0.043).In hypertensive patients with TRH, we observed a decrease of pulsed RCF 6 M and 12 M after RDN and an increase of vasodilatory capacity, in parallel to decreases in BP and heart rate. The reduction of pulsed RCF after RDN implies a decrease of shear stress on the vascular wall by the pulsed blood flow. This and the increment of vasodilatory capacity suggest an improvement of retinal (and potentially cerebral) microcirculation.
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Retrospective fusion of F-18-FDG-PET and CT: additional diagnostic information in melanoma patients - Römer, Wolfgang; Nömayr, Anton; Greess, Holger; Fiedler, Ekkehard; Platsch, Günter; Pfahlberg, Annette; Hothorn, Torsten; Hornegger, Joachim; Bautz, Werner; Kuwert, Torsten (Eur J Nucl Med Mol Imaging, 2004)

Retrospective fusion of F-18-FDG-PET and CT: additional diagnostic information in melanoma patients. - Römer, Wolfgang; Nömayr, Anton; Greess, Holger; Fiedler, Ekkehard; Platsch, Günter; Pfahlberg, Annette; Hothorn, Torsten; Hornegger, Joachim; Bautz, Werner; Kuwert, Torsten (Philadelphia J Nucl Med, 2004)

Retrospective interactive rigid fusion of 18F-FDG-PET and CT: Additional diagnostic information in melanoma patients - Römer, Wolfgang; Nömayr, Anton; Greess, Holger; Fiedler, Ekkehard; Platsch, Günter; Schuler-Thurner, Beatrice; Pfahlberg, Annette; Hothorn, Torsten; Schuler, Gerold; Hornegger, Joachim; Bautz, Werner; Kuwert, Torsten (Nuklearmedizin-Nuclear Medicine, 2006)
Aim: This study investigates whether interactive rigid fusion of routine PET and CT data improves localization, detection and characterization of lesions compared to separate reading. For this purpose, routine PET and CT scans of patients with metastases from malignant melanoma were used. Patients, methods: In 34 patients with histologically confirmed malignant melanoma, FDG-PET and spiral CT were performed using clinical standard protocols. For all of these patients, gold standard was available. Clinical and radiological follow-up identified 82 lesions as definitely pathological. Two board-certified nuclear medicine physicians and two board-certified radiologists analyzed PET and CT images independently from each other. For each patient up to 32 anatomical regions (24 lymph node regions, 8 extranodular regions) were systematically classified. Discordant areas were interactively analyzed in manually and rigidly registered images using a commercially available fusion tool. No side-by-side reading was performed. Results: Image fusion disclosed that the evaluation of the PET images alone led to a mislocalization in 26 of 91 focally FDG enhancing lesions. The overall sensitivities of PET, CT, and image fusion were 85, 88, and 94%, respectively; the overall specificities of PET, CT and image fusion were 98, 95 and 100%, respectively. Image fusion exhibited statistically significant higher specificity values as compared with CT. Ten definitely malignant sites were false-negative in CT, but could be detected by PET. On the other hand, twelve metastases were false-negative in PET, but could be detected by CT. These included two lesions, which had a clear correlate on the PET image when the fused images were evaluated. On the whole, registration of the PET and CT images yielded additional diagnostic information in 44% of the definitely malignant lesions. Conclusion: Retrospective image fusion of independently obtained PET and CT data is particularly valuable in exactly lodizing foci of abnormal FDG uptake and improves the detection of metastases of malignant melanoma. © 2006 Schattauer GmbH.

Revealing hidden potentials of the q-space signal in breast cancer - Jäger, Paul F.; Bickelhaupt, Sebastian; Laun, Frederik Bernd; Lederer, Wolfgang; Heidi, Daniel; Kuder, Tristan Anselm; Paech, Daniel; Bonekamp, David; Radbruch, Alexander; Delorme, Stefan; Schlemmer, Heinz Peter; Steudle, Franziska; et al. (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2017)
Mammography screening for early detection of breast lesions currently suffers from high amounts of false positive findings, which result in unnecessary invasive biopsies. Diffusion-weighted MR images (DWI) can help to reduce many of these false-positive findings prior to biopsy. Current approaches estimate tissue properties by means of quantitative parameters taken from generative, biophysical models fit to the q-space encoded signal under certain assumptions regarding noise and spatial homogeneity. This process is prone to fitting instability and partial information loss due to model simplicity. We reveal unexplored potentials of the signal by integrating all data processing components into a convolutional neural network (CNN) architecture that is designed to propagate clinical target information down to the raw input images. This approach enables simultaneous and target-specific optimization of image normalization, signal exploitation, global representation learning and classification. Using a multicentric data set of 222 patients, we demonstrate that our approach significantly improves clinical decision making with respect to the current state of the art.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Convolutional networks; Deep learning; Diffusion imaging; Diffusion Kurtosis Imaging; Lesion classification

Rheumatoid vasculitis of the central nervous system - Lee, D. H.; Blinzler, C.; Stöckl, Thomas; Engelhorn, Tobias; Buslei, R.; Schwab, Sibylle; Linker, Ralf (Der Nervenarzt, 2015)
EVALuna2:7259

Robust blood flow velocity estimation from 3D rotational angiography - Bögel, Marco; Gehrisch, S.; Redel, T.; Rohkohl, C.; Birkhold, A.; Hölter, Philip; Maier, Andreas; Kowarschik, M.; Dörfler, Arnd (Proceedings - International Conference on Image Processing, ICIP, 2018)
Blood flow velocity estimation techniques from 2D fluoroscopy and more recently rotational angiography images represent a topic of wide interest in various clinical research areas. In particular, they can be an important step towards patient-specific flow simulations. Additionally, it can be of diagnostic interest to evaluate volumetric blood flow in stenotic vessel segments; e.g. in a patient's brain. In this work, we present a robust optimization-based approach to estimate mean blood flow velocities from rotational digital subtraction angiography (DSA) images. Our method was extensively evaluated on 70 simulated datasets and 6 clinical datasets with MR phase contrast ground truth data. Our evaluation explores the limitations of image-based velocity estimation; i.e., measurements over short or small vessel segments. Overall, we were able to estimate the mean velocity with average errors as little as 4% for simulation studies, if the vessel segment is sufficiently long, and achieved results within the confines of the MR phase contrast ground truth data for our clinical data, with an average relative error to the centerline measurement of 9.5%±10.5%. The achieved accuracy enables patient-specific hemodynamic simulations and may also be of immediate diagnostic interest.
CRIS-Team Scopus Importer:2022-06-05
Keywords: Angiography; Contrast medium; Flow quantification; Velocity estimation

Role of imaging for eligibility and safety of a-NGF clinical trials - Roemer, Frank; Hochberg, Marc C.; Carrino, John A.; Kompel, Andrew J.; Diaz, Luis; Hayashi, Daichi; Crema, Michel D.; Guermazi, Ali (Therapeutic Advances in Musculoskeletal Disease, 2023)
Nerve growth factor (a-NGF) inhibitors have been developed for pain treatment including symptomatic osteoarthritis (OA) and have proven analgesic efficacy and improvement in functional outcomes in patients with OA. However, despite initial promising data, a-NGF clinical trials focusing on OA treatment had been suspended in 2010. Reasons were based on concerns regarding accelerated OA progression but were resumed in 2015 including detailed safety mitigation based on imaging. In 2021, an FDA advisory committee voted against approving tanezumab (one of the a-NGF compounds being evaluated) and declared that the risk evaluation and mitigation strategy was not sufficient to mitigate potential safety risks. Future clinical trials evaluating the efficacy of a-NGF or comparable molecules will need to define strict eligibility criteria and will have to include strategies to monitor safety closely. While disease-modifying effects are not the focus of a-NGF treatments, imaging plays an important role to evaluate eligibility of potential participants and to monitor safety during the course of these studies. Aim is to identify subjects with on-going safety findings at the time of inclusion, define those potential participants that are at increased risk for accelerated OA progression and to withdraw subjects from on-going studies in a timely fashion that exhibit imaging-confirmed structural safety events such as rapid progressive OA. OA efficacy- and a-NGF studies apply imaging for different purposes. In OA efficacy trials image acquisition and evaluation aims at maximizing sensitivity in order to capture structural effects between treated and non-treated participants in longitudinal fashion. In contrast, the aim of imaging in a-NGF trials is to enable detection of structural tissue alterations that either increase the risk of a negative outcome (eligibility) or may result in termination of treatment (safety).
CRIS-Team Scopus Importer:2023-07-07
Keywords: a-NGF; clinical trials; eligibility; MRI; nerve growth factor; osteoarthritis; radiography; safety

Role of Thigh Muscle Changes in Knee Osteoarthritis Outcomes: Osteoarthritis Initiative Data - Mohajer, Bahram; Dolatshahi, Mahsa; Moradi, Kamyar; Najafzadeh, Nima; Eng, John; Zikria, Bashir; Wan, Mei; Cao, Xu; Roemer, Frank; Guermazi, Ali; Demehri, Shadpour (Radiology, 2022)
Background: Longitudinal data on the association of quantitative thigh muscle MRI markers with knee osteoarthritis (KOA) outcomes are scarce. These associations are of clinical importance, with potential use for thigh muscle–directed disease-modifying interventions. Purpose: To measure KOA-associated longitudinal changes in MRI-derived muscle cross-sectional area (CSA) and adipose tissue and their association with downstream symptom worsening and knee replacement (KR). Materials and Methods: In a secondary analysis of the Osteoarthritis Initiative multicenter prospective cohort (February 2004 through October 2015), knees of participants with available good-quality thigh MRI scans at baseline and at least one follow-up visit were included and classified as with and without KOA according to baseline radiographic Kellgren-Lawrence grade of 2 or higher and matched for confounders with use of propensity score matching. An automated deep learning model for thigh MRI two-dimensional segmentation was developed and tested. Markers of muscle CSA and intramuscular adipose tissue (intra-MAT) were measured at baseline and 2nd- and 4th-year follow-up (period 1) and compared between knees with and without KOA by using linear mixed-effect regression models. Furthermore, in knees with KOA, the association of period 1 changes in muscle markers with risk of KR (Cox proportional hazards) and symptom worsening (mixed-effect models) during the 4th to 9th year (period 2) was evaluated. Results: This study included 4634 matched thighs (2317 with and 2317 without KOA) of 2344 participants (mean age, 62 years 6 9 [SD]; 1292 women). Compared with those without, knees with KOA had a decrease in quadriceps CSA (mean difference, 28.21 mm2/year; P = .004) and an increase in quadriceps intra-MAT (1.98 mm2/year; P = .007). Decreased CSA and increased intra-MAT of quadriceps during period 1 was predictive of downstream (period 2) KOA symptom worsening (Western Ontario and McMaster Universities Osteoarthritis Index total score: odds ratio, 0.24 [negative association] [P , .001] and 1.38 [P = .012], respectively). Quadriceps CSA changes were negatively associated with higher future KR risk (hazard ratio, 0.70; P , .001). Conclusion: Knee osteoarthritis was associated with longitudinal MRI-derived decreased quadriceps cross-sectional area and increased intramuscular adipose tissue. These potentially modifiable risk factors were predictive of downstream symptom worsening and knee replacement.
CRIS-Team Scopus Importer:2022-10-28

RREB1::MRTFB fusion-positive extra-glossal mesenchymal neoplasms: A series of five cases expanding their anatomic distribution and highlighting significant morphological and phenotypic diversity - Agaimy, Abbas; Din, Nasir Ud; Dermawan, Josephine K.; Haller, Florian; Melzer, Katja; Denz, Axel; Baumhoer, Daniel; Stöhr, Robert; Grützmann, Robert; Antonescu, Cristina R. (Genes Chromosomes & Cancer, 2022)
The RREB1::MRTFB (former RREB1::MKL2) fusion characterizes ectomesenchymal chondromyxoid tumors (EMCMT) of the tongue. Only five molecularly confirmed extra-glossal EMCMT cases have been reported recently; all occurring at head and neck or mediastinal sites. We herein describe five new cases including the first two extracranial/extrathoracic cases. The tumors occurred in three male and two female patients with an age ranging from 18 to 61 years (median, 28). Three tumors were located in the head and neck (jaw, parapharyngeal space, and nasopharyngeal wall) and two in the soft tissue (inguinal and presacral). The tumor size ranged from 3.3 to 20 cm (median, 7). Treatment was surgical without adjuvant treatment in all cases. Two cases were disease-free at 5 and 17 months; other cases were lost to follow-up. Histologically, the soft tissue cases shared a predominant fibromyxoid appearance, but with variable cytoarchitectural pattern (cellular perineurioma-like whorls and storiform pattern in one case and large polygonal granular cells embedded within a chondromyxoid stroma in the other). Two tumors (inguinal and parapharyngeal) showed spindled to ovoid and round cells with a moderately to highly cellular nondescript pattern. One sinonasal tumor closely mimicked nasal chondromesenchymal hamartoma (NCMH). Mitotic activity was low (0-5 mitoses/10 hpfs). Immunohistochemical findings were heterogeneous with variable expression of S100 (2/5), EMA (2/3), CD34 (1/4), desmin (1/4), and GFAP (1/3). Targeted RNA sequencing revealed the same RREB1::MRTFB fusion in all cases, with exon 8 of RREB1 being fused to exon 11 of MRTFB. This study expands the topographic spectrum of RREB1::MRTFB fusion-positive mesenchymal neoplasms, highlighting a significant morphological and phenotypic diversity. Overall, RREB1::MRTFB-rearranged neoplasms seem to fall into two subcategories: tumors with lobulated, chondroid, or myxochondroid epithelioid morphology (Cases 2 and 3) and those with more undifferentiated hypercellular spindle cell phenotype (Cases 1, 4, and 5). Involvement of extracranial/extrathoracic sites and the NCMH-like pattern are novel. The biology of these likely indolent or benign tumors remains to be verified in the future.
CRIS-Team WoS Importer:2022-07-29

Rückenschmerz: Aktuelle Entwicklungen und Leitlinien - Braunschweig, R.; Janka, Rolf Matthias; Spahn, G.; Tiemann, A. (Radiologe, 2019)
Pain in general and back pain in particular are associated with a variety of pathological, clinical, and sociocultural factors. There are numerous clinical and therapeutic treatment as well as imaging-options available and comprehensive knowledge is required to meet the individual clinical needs of those affected. This requires a high degree of interdisciplinary cooperation. In addition, back pain is covered differently by various numbers of insurance companies. Imaging methods, including the example of periradicular image-assisted interventions, are presented with regard to their indication and efficiency. The existing guidelines and evaluation recommendations with different structural and targeted approaches are discussed in addition to extensive legal aspects in the literature. In addition, the structured reports and the certificated curricula of the AG Bildgebende Verfahren des Bewegungsapparates (Working Group „Imaging Procedures of the Musculoskeletal System”) of the Deutsche Röntgengesellschaft (“German Society of Radiology”) are recommended for the quality assurance.
CRIS-Team Scopus Importer:2019-12-20
Keywords: Backache; Computed tomography; Magnetic resonance imaging; Quality assurance; Standards

Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial - Nogueira, Raul G.; Frei, Donald; Kirmani, Jawad F.; Zaidat, Osama; Lopes, Demetrius; Turk, Aquilla S.; Heck, Donald; Mason, Brian; Haussen, Diogo C.; Levy, Elad I.; Mehta, Siddhart; Lazzaro, Marc; et al. (JAMA Neurology, 2018)
Importance: The treatment effects of individual mechanical thrombectomy devices in large-vessel acute ischemic stroke (AIS) remain unclear. Objective: To determine whether the novel 3-dimensional (3-D) stent retriever used in conjunction with an aspiration-based mechanical thrombectomy device (Penumbra System; Penumbra) is noninferior to aspiration-based thrombectomy alone in AIS. Design, Setting, and Participants: This randomized, noninferiority clinical trial enrolled patients at 25 North American centers from May 19, 2012, through November 19, 2015, with follow-up for 90 days. Adjudicators of the primary end points were masked to treatment allocation. Patients with large-vessel intracranial occlusion AIS presenting with a National Institutes of Health Stroke Scale (NIHSS) score of at least 8 within 8 hours of onset underwent 1:1 randomization to 3-D stent retriever with aspiration or aspiration alone. The primary analyses were conducted in the intention-to-treat population. Interventions: Mechanical thrombectomy using intracranial aspiration with or without the 3-D stent retriever. Main Outcomes and Measures: The primary effectiveness end point was the rate of a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2 to 3 with a 15% noninferiority margin. Device- and procedure-related serious adverse events at 24 hours were the primary safety end points. Results: Of 8082 patients screened, 198 patients were enrolled (111 women [56.1%] and 87 men [43.9%]; mean [SD] age, 66.9 [13.0] years) and randomized, including 98 in the 3-D stent retriever with aspiration group and 100 in the aspiration alone group; an additional 238 patients were eligible but not enrolled. The median baseline NIHSS score was 18.0 (interquartile range, 14.0-23.0). Eighty-two of 94 patients in the 3-D stent retriever and aspiration group (87.2%) had an mTICI grade of 2 to 3 compared with 79 of 96 in the aspiration alone group (82.3%; difference, 4.9%; 90% CI, -3.6% to 13.5%). None of the other measures were significantly different between the 2 groups. Device-related serious adverse events were reported by 4 of 98 patients in the 3-D stent retriever with aspiration group (4.1%) vs 5 of 100 patients in the aspiration only group (5.0%); procedure-related serious adverse events, 10 of 98 (10.2%) vs 14 of 100 (14.0%). A 90-day modified Rankin Scale score of 0 to 2 was reported by 39 of 86 patients in the 3-D stent retriever with aspiration group (45.3%) vs 44 of 96 patients in the aspiration only group (45.8%). Conclusions and Relevance: The present study provides class 1 evidence for the noninferiority of the 3-D stent retriever with aspiration vs aspiration alone in AIS. Future trials should evaluate whether these results can be generalized to other stent retrievers. Trial Registration: clinicaltrials.gov Identifier: NCT01584609.
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Safety of Intra-articular Corticosteroid Injection Response - Guermazi, Ali; Kompel, Andrew J.; Murakami, Akira M.; Diaz, Luis E.; Crema, Michel D.; Roemer, Frank (Radiology, 2020)
CRIS-Team WoS Importer:2020-04-10

Sample size estimation: Current practice and considerations for original investigations in MRI technical development studies - Hanspach, Jannis; Nagel, Armin Michael; Hensel, Bernhard; Uder, Michael; Koros, Leon; Laun, Frederik Bernd (Magnetic Resonance in Medicine, 2020)
Purpose: To investigate and to provide guidance for sample size selection based on the current practice in MR technical development studies in which healthy volunteers are examined. Methods: All original articles published in Magnetic Resonance in Medicine between 2017 and 2019 were investigated and categorized according to technique, anatomical region, and magnetic field strength. The number of examined healthy volunteers (ie, the sample size) was collected and evaluated, whereas the number of patients was not considered. Papers solely measuring patients, animals, phantoms, specimens, or studies using existing data, for example, from an open databank, or consisting only of theoretical work or simulations were excluded. Results: The median sample size of the 882 included studies was 6. There were some peaks in the sample size distribution (eg, 1, 5, and 10). In 49.9%, 82.1%, and 95.6% of the studies, the sample size was smaller or equal to 5, 10, and 20, respectively. Conclusion: We observed a large variance in sample sizes reflecting the variety of studies published in Magnetic Resonance in Medicine. Therefore, it can be concluded that it is current practice to balance the need for statistical power with the demand to minimize experiments involving healthy humans, often by choosing small sample sizes between 1 and 10. Naturally, this observation does not release an investigator from ensuring that sufficient data are acquired to reach statistical conclusions.
CRIS-Team Scopus Importer:2020-10-23
Keywords: current practice; methodological MRI developments; number of subjects; number of volunteers; proof-of-principle studies; sample size estimation

Sarcopenia Assessments as Predictors of Overall Survival in Patients with Metastatic Renal Cell Carcinoma - Kuemmerl, Luca; Lesyuk, Wladimir; Goebell, Peter; Kahlmeyer, Andreas (ONCOLOGY RESEARCH AND TREATMENT, 2020)
CRIS-Team WoS Importer:2020-03-20

Sarcopenia assessments as predictors of overall survival in patients with metastatic renal cell carcinoma - Kümmerl, Luca; Kraulich, Matthias; Lesyuk, Wladimir; Binninger, Adrian; Goebell, Peter; Kahlmeyer, Andreas (Urologic Oncology-Seminars and Original Investigations, 2023)
Background: Sarcopenia represents an important prognostic marker in tumor patients. However, measurement methods and threshold values are not uniformly defined. The aim of this study is therefore to determine the prognostic value of current definitions of sarcopenia in patients with metastatic renal cell carcinoma treated with tyrosine-kinase-inhibitors (TKIs). Methods: In 93 patients with metastatic renal cell carcinoma, sarcopenia was assessed based on manually assisted software measurements of sarcopenia indices based on different muscle areas. Whole muscle area and psoas muscle area at L3 were estimated and adjusted to patient's height in routine CT imaging before the start of first-line TKI therapy. The correlation of different sarcopenia definitions to overall survival was investigated in a univariate analysis as well as in a multivariate analysis. Results: The mean patients’ age at inclusion was 65.8 years (21–86 years). Median survival was 12.3 months (IQR: 5.7–29.8 months), and mean survival was 18.8 months (SD: 17.2 months). As the definitions of sarcopenia differ considerably, 7.6% to 96.7% of the patients were classified as sarcopenic. In univariate analysis, sarcopenia was significantly associated with overall survival. Multivariate analysis, taking into account the Memorial Sloan Kettering Cancer Center risk score, revealed that some sarcopenia-indices are additional and independent prognostic markers. The risk of death was approximately doubled in sarcopenic patients. Conclusions: Sarcopenia is an important prognostic factor in patients with metastatic renal cell carcinoma treated with TKIs. Multivariate analysis demonstrates a doubling of the risk of death in sarcopenic patients. The assessment of sarcopenia can be performed by the analysis of routine staging imaging using indices of the total muscle area or the psoas muscle area.
CRIS-Team Scopus Importer:2023-08-18
Keywords: Overall survival; Prognostic factor; Psoas muscle; Renal cell carcinoma; Sarcopenia; Skeletal muscle; Tyrosine kinase inhibitors

Scanned versus Fused-Reconstructed Oblique MR-Images for Assessment of the Tibiofibular Syndesmosis-Diagnostic PerFormance and Reader Agreement - Seuß, Hannes; Hammon, Matthias; Roemer, Frank; Heiß, Rafael; Janka, Rolf Matthias; Uder, Michael; Dankerl, Peter (Diagnostics, 2021)
To evaluate the diagnostic performance and reader agreement of a novel MRI image fusion method enabling the reconstruction of oblique images for the assessment of the tibiofibular syndesmosis. We evaluated 40 magnetic resonance imaging examinations of patients with ankle sprains (16 with ruptures and 24 without) for the presence of anteroinferior tibiofibular ligament rupture. For all patients, we performed a fusion of standard two-dimensional transversal and coronal 3 mm PDw TSE images into an oblique-fusion reconstruction (OFR) and compared these against conventionally scanned oblique sequence for the evaluation of the tibiofibular syndesmosis. To evaluate diagnostic performance, two expert readers independently read the OFR images twice. We analyzed sensitivity, specificity, negative and positive predictive values, accuracy, and agreement. Reader 1 misinterpreted one OFR as a false negative, demonstrating a sensitivity of 0.94 and specificity of 1.00, reader 2 demonstrated perfect accuracy. Intrareader agreement was almost perfect for reader 1 (alpha = 0.95) and was perfect for reader 2 (alpha = 1.00). Additionally, interreader agreement between all fusion sequence reads was almost perfect (alpha = 0.97). The proposed OFR enables reliable detection of anteroinferior tibiofibular ligament rupture with excellent inter- and intrareader agreement, making conventional scanning of oblique images redundant and supplies a method to retroactively create oblique images, e.g., from external examinations.
CRIS-Team WoS Importer:2021-03-19

Scapholunate advanced collapse: a pictorial review - Tischler, Brian T.; Diaz, Luis E.; Murakami, Akira M.; Roemer, Frank; Goud, Ajay R.; Arndt, William F.; Guermazi, Ali (Insights into Imaging, 2014)
Scapholunate advanced collapse (SLAC) is the most common cause of osteoarthritis involving the wrist. Along with clinical investigation, radiological studies play a vital role in the diagnosis of SLAC wrist. Given that the osteoarthritic changes that are seen with SLAC occur in a predictable progressive pattern, it is important to understand the pathological evolution of SLAC to be able to recognise the associated progressive imaging findings seen with this disease process. Focusing on radiological findings, this article provides a pictorial review of the anatomy of the scapholunate interosseous ligament as well as the common terminology and biomechanical alterations seen in the pathway leading to the development of SLAC arthropathy. We will then discuss two additional common causes of SLAC wrist and their imaging findings, namely scaphoid non-union advanced collapse and calcium pyrophosphate dehydrate disease. In addition, we will provide a brief overview of the current treatment options of these pathological entities.o SLAC is the most common cause of osteoarthritis involving the wrist. o Arthritic changes of SLAC occur in a predictable progressive pathological and radiographic pattern. o Imaging is key for diagnosing, monitoring progression and assessing post-treatment changes of SLAC.
EVALuna2:14576

Scoring osteoarthritis reliably in large joints and the spine using whole-body ct: Osteoarthritis computed tomography-score (oact-score) - Gielis, Willem Paul; Weinans, Harrie; Nap, Frank J.; Roemer, Frank; Foppen, Wouter (Journal of Personalized Medicine, 2021)
A standardized method to assess structural osteoarthritis (OA) burden thorough the body lacks from literature. Such a method can be valuable in developing personalized treatments for OA. We developed a reliable scoring system to evaluate OA in large joints and the spine—the OsteoArthritis Computed Tomography (OACT) score, using a convenience sample of 197 whole-body low-dose non-contrast CTs. An atlas, containing example images as reference points for training and scoring, are presented. Each joint was graded between 0–3. The total OA burden was calculated by summing scores of individual joints. Intra-and inter-observer reliability was tested 25 randomly selected scans (N = 600 joints). Intra-observer reliability and inter-observer reliability between three observers was assessed using intraclass correlation coefficient (ICC) and square-weighted kappa statistics. The square-weighted kappa for intra-observer reliability for OACT-score at joint-level ranged from 0.79 to 0.95; the ICC for the total OA grade was 0.97 (95%-CI, 0.94 to 0.99). Square-weighted kappa for interobserver reliability ranged from 0.48 to 0.95; the ICC for the total OA grade was 0.95 (95%-CI, 0.90 to 0.98). The OACT score, a new reproducible CT-based grading system reflecting OA burden in large joints and the spine, has a satisfactory reproducibility. The atlas can be used for research purposes, training, educational purposes and systemic grading of OA on CT-scans.
CRIS-Team Scopus Importer:2021-01-15
Keywords: Computed tomography; Image analysis; Osteoarthritis; Reliability

Scrutinizing the cut-off for "pathological" meniscal body extrusion on knee MRI - Svensson, F.; Felson, D. T.; Turkiewicz, A.; Guermazi, A.; Roemer, Frank; Neuman, P.; Englund, M. (European Radiology, 2019)
ObjectivesMedial meniscal body extrusion 3mm on MRI is often considered pathologic. The aims of this study were to (1) assess the adequacy of 3mm as cut-off for pathological extrusion and (2) find an optimal cut-off for meniscal extrusion cross-sectionally associated with radiographic knee osteoarthritis, bone marrow lesions (BMLs), and cartilage damage.MethodsNine hundred fifty-eight persons, aged 50-90years from Framingham, MA, USA, had readable 1.5T MRI scans of the right knee for meniscal body extrusion (measured in mm). BMLs and cartilage damage were read using the whole organ magnetic resonance imaging score (WORMS). Knee X-rays were read according to the Kellgren and Lawrence (KL) scale. We evaluated the performance of the 3-mm cut-off with respect to the three outcomes and estimated a new cut-off maximizing the sum of sensitivity and specificity.ResultsThe study persons had mean age of 62.2years, 57.0% were women and the mean body mass index was 28.5kg/m(2). Knees with radiographic osteoarthritis, BMLs, and cartilage damage had overall more meniscal extrusion than knees without. The 3-mm cut-off had moderate sensitivity and low specificity for all three outcomes (sensitivity between 0.68 [95% CI 0.63-0.73] and 0.81 [0.73-0.87], specificity between 0.49 [0.45-0.52] and 0.54 [0.49-0.58]). Using 4mm maximized the sum of sensitivity and specificity and improved the percentage of correctly classified subjects (from between 54 and 61% to between 64 and 79%).ConclusionsThe 4-mm cut-off may be used as an alternative cut-off for denoting pathological meniscal extrusion.Key Points center dot Medial meniscal body extrusion is strongly associated with osteoarthritis.center dot The 3-mm cut-off for medial meniscal body extrusion has high sensitivity but low specificity with respect to bone marrow lesions, cartilage damage, and radiographic osteoarthritis.center dot The 4-mm cut-off maximizes the sensitivity and specificity with respect to all three osteoarthritis features.
CRIS-Team WoS Importer:2019-04-16

Secondary Reconstruction of Posttraumatic Enophthalmos: Prefabricated Implants vs Titanium Mesh - Nkenke, Emeka; Vairaktaris, Eleftherios; Spitzer, Martin; Kramer, Manuel; Stamminger, Marc; Holbach, Leonard; Knipfer, Christian; Stelzle, Florian (Archives of Facial Plastic Surgery, 2011)
Objective To compare individually prefabricated computer-assisted designed/computer-assisted manufactured (CAD/CAM) glass-bioceramic implants with nonpreformed titanium meshes for orbital floor reconstruction in secondary correction of enophthalmos. Methods In a nonrandomized, comparative, prospective cohort study, 2 groups of 10 patients received secondary correction of enophthalmos with CAD/CAM implants in one group and titanium meshes in the other. Relative enophthalmometry and exophthalmometry data were assessed preoperatively, at the end of the operation, at day 90 postoperatively, and at day 365 postoperatively. Results In both groups, the globe position improved significantly at the end of the operation (P = .005 in both groups). At day 90, there was a significant tendency toward relapse of enophthalmos in both groups (P = .005 in the CAD/CAM group and P = .008 in the titanium mesh group). However, the globe position did not change significantly between postoperative days 90 and 365 in both groups (P = .57 in the CAD/CAM group and P = .35 in the titanium mesh group). Conclusions Individually prefabricated CAD/CAM glass-bioceramic implants and nonpreformed titanium meshes produce similar results in secondary enophthalmos correction. Because of higher costs, the use of CAD/CAM implants should be confined to selected cases in secondary enophthalmos correction.
EVALuna2:21025

Secretory Capacity of Pancreatic Beta-Cells Is Enhanced 6 Months After Renal Denervation in Hypertensive Patients - Ott, Christian; Schmid, Axel; Mahfoud, Felix; Akarca, Ertan; Kistner, Iris; Ditting, Tilmann; Veelken, Roland; Boehm, Michael; Uder, Michael; Schmieder, Roland (Journal of the American College of Cardiology, 2018)
EVALuna2:35226

Segmentation of Cerebral Vasculature - Alicioglu, Yesim; Spiegel, Martin; Wimmer, Andreas; Struffert, Tobias; Hornegger, Joachim; Dörfler, Arnd (Proceedings of the 5th Russian-Bavarian Conference on Biomedical Engineering, 2009)

Segmentation of the fascia lata and reproducible quantification of intermuscular adipose tissue (IMAT) of the thigh - Chaudry, Oliver; Friedberger, Andreas; Grimm, Alexandra; Uder, Michael; Nagel, Armin Michael; Kemmler, Wolfgang; Engelke, Klaus (Magnetic Resonance Materials in Physics Biology and Medicine, 2020)
Objective: To develop a precise semi-automated segmentation of the fascia lata (FL) of the thigh to quantify IMAT volume in T1w MR images and fat fraction (FF) in Dixon MR images. Materials and methods: A multi-step segmentation approach was developed to identify fibrous structures of the FL and combining them into a closed 3D surface. 23 healthy young men with low and 50 elderly sarcopenic men with moderate levels of IMAT were measured by T1w and 6pt Dixon MRI at 3T. 20 datasets were used to determine reanalysis precision errors. IMAT volume was compared using the new FL segmentation versus an easier to segment but less accurate, tightly fitting envelope of the thigh muscle ensemble. Results: The segmentation was successfully applied to all 73 datasets and took about 7 min per 28 slices. In particular, in elderly subjects, it includes a large amount of adipose tissue below the FL typically not accounted for in other segmentation approaches. Inter- and intra-operator RMS-CVs were 0.33% and 0.14%, respectively, for IMAT volume and 0.04% and 0.02%, respectively, for FFMT. Discussion: The FL segmentation is an important step to quantify IMAT with high precision and may be useful to investigate effects of aging and treatment on changes of IMAT and FF. ClinicalTrials.gov identifier NCT2857660, August 5, 2016. Trial registration: ClinicalTrials.gov identifier NCT2857660, August 5, 2016.
CRIS-Team Scopus Importer:2020-08-14
Keywords: Adipose tissue; Fascia lata; MRI

Seizures among long-term survivors of conservatively treated ICH patients: incidence, risk factors, and impact on functional outcome - Madzar, Dominik; Kuramatsu, Joji; Gollwitzer, Stephanie; Lücking, Hannes; Kloska, Stephan; Hamer, Hajo; Köhrmann, Martin; Huttner, Hagen (Neurocritical Care, 2014)
Seizures are a common complication after intracerebral hemorrhage (ICH) but there is a substantial lack of information on the long-term incidence in ICH survivors and whether post-ICH seizures affect functional long-term outcome.Over a five-year period 464 consecutive patients with spontaneous ICH were analyzed. Focussing on 1-year ICH survivors, clinical, and radiological parameters were retrieved from institutional prospective databases. The occurrence of seizures was categorized as early (<=7 days) or late (>7 days). Functional outcome was assessed by mailed questionnaires and telephone interviews, and was categorized into good vs. poor (mRS: 0-2 vs. 3-5) and favorable vs. unfavorable (mRS: 0-3 vs. 4-5). Multivariate regression models were calculated to investigate risk factors associated with post-ICH seizures including an a priori defined subgroup analysis of lobar ICH patients.Among 203 long-term ICH survivors, 19.7 % developed seizures of which 55 % occurred late. Factors associated with seizures were lobar location (OR 8.10; 95 % CI 3.04-21.59; p < 0.001), sepsis (OR 4.59; 95 % CI 1.20-17.53; p = 0.026), and history of alcohol abuse (OR 3.36; 95 % CI 1.25-9.06; p = 0.017). Subgroup analysis of lobar ICH patients revealed history of alcohol abuse as the only independent predictor of post-ICH seizures (OR 5.22; 95 % CI 1.25-21.78; p = 0.024). Functional long-term outcome among survivors was slightly worse in patients with post-ICH seizures (p = 0.059). In multivariate regression modeling for prediction of poor outcome, the parameter "post-ICH seizures" again reached a statistical trend (p = 0.065), and established parameters such as age, GCS, and hemorrhage volume were independently related to poor outcome.Post-ICH seizures among long-term ICH survivors are common and may contribute to unfavorable functional outcome. Especially lobar ICH patients with a history of alcohol abuse are at risk to develop post-ICH seizures. Therefore, this subgroup may represent a target population for a prophylactic anticonvulsive treatment approach, preferably investigated in a prospective randomized trial.
EVALuna2:22307

Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland - Hader, Christopher; Uder, Michael; Loose, R. W. R.; Linnemann, U.; Bertsch, T.; Adamus, R. (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2016)
Purpose: Evaluation of the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics. Materials and Methods: In a retrospective study, all patients (n = 23) with primary (n = 21) or tertiary (n = 2) hyperparathyroidism were evaluated from 2005 to 2016 at the Hospital Nuremberg-North. These patients all received one (n = 20) or more (n = 3) SVS. 15 patients had one or more previous unsuccessful surgeries (group A), 8 patients received the SVS primarily before the first surgery (group B). Results of SVS were compared with the results of surgery, non-invasive diagnostic procedures and clinical follow up. Results: In 24 out of 26 SVS a significant PTH peak was found. 19 patients underwent surgery after SVS. In 16 of these cases (84 %) the SVS peak was concordant with the intraoperative localization. Thus, SVS of all operated patients had a sensitivity of 94 %. Considering only patients with prior HPT surgery the sensitivity was 89 %. In none of the 26 examinations complications occurred. Conclusion: Our results demonstrate that selective venous blood sampling SVS in cases with unclear imaging of parathyroid adenomas is an effective and low-risk invasive diagnostic method to localize parathyroid adenomas and helps to improve surgical therapy. Key points: o?low risk invasive diagnostic procedure to localize parathyroid adenomaso?additional step if non-invasive diagnostics are negative or inconclusiveo?high sensitivity in the detection of parathyroid adenomas Citation Format: o?Hader C, Uder M, Loose RWR et al. Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland. Fortschr Röntgenstr 2016; 188: 1144 - 1150.
EVALuna2:14609

Semantic representation of reported measurements in radiology - Oberkampf, Heiner; Zillner, Sonja; Overton, James A.; Bauer, Bernhard; Uder, Michael; Hammon, Matthias; Cavallaro, Alexander Josef (BMC Medical Informatics and Decision Making, 2016)
In radiology, a vast amount of diverse data is generated, and unstructured reporting is standard. Hence, much useful information is trapped in free-text form, and often lost in translation and transmission. One relevant source of free-text data consists of reports covering the assessment of changes in tumor burden, which are needed for the evaluation of cancer treatment success. Any change of lesion size is a critical factor in follow-up examinations. It is difficult to retrieve specific information from unstructured reports and to compare them over time. Therefore, a prototype was implemented that demonstrates the structured representation of findings, allowing selective review in consecutive examinations and thus more efficient comparison over time.We developed a semantic Model for Clinical Information (MCI) based on existing ontologies from the Open Biological and Biomedical Ontologies (OBO) library. MCI is used for the integrated representation of measured image findings and medical knowledge about the normal size of anatomical entities. An integrated view of the radiology findings is realized by a prototype implementation of a ReportViewer. Further, RECIST (Response Evaluation Criteria In Solid Tumors) guidelines are implemented by SPARQL queries on MCI. The evaluation is based on two data sets of German radiology reports: An oncologic data set consisting of 2584 reports on 377 lymphoma patients and a mixed data set consisting of 6007 reports on diverse medical and surgical patients. All measurement findings were automatically classified as abnormal/normal using formalized medical background knowledge, i.e., knowledge that has been encoded into an ontology. A radiologist evaluated 813 classifications as correct or incorrect. All unclassified findings were evaluated as incorrect.The proposed approach allows the automatic classification of findings with an accuracy of 96.4 % for oncologic reports and 92.9 % for mixed reports. The ReportViewer permits efficient comparison of measured findings from consecutive examinations. The implementation of RECIST guidelines with SPARQL enhances the quality of the selection and comparison of target lesions as well as the corresponding treatment response evaluation.The developed MCI enables an accurate integrated representation of reported measurements and medical knowledge. Thus, measurements can be automatically classified and integrated in different decision processes. The structured representation is suitable for improved integration of clinical findings during decision-making. The proposed ReportViewer provides a longitudinal overview of the measurements.
EVALuna2:14471

Semi-automated De-identification of German Content Sensitive Reports for Big Data Analytics - Seuß, Hannes; Dankerl, Peter; Ihle, Matthias; Grandjean, Andrea; Hammon, Rebecca; Kaestle, Nicola; Fasching, Peter; Maier, Christian; Christoph, Jan; Sedlmayr, Martin; Uder, Michael; Hammon, Matthias; et al. (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2017)
Purpose Projects involving collaborations between different institutions require data security via selective de-identification of words or phrases. A semi-automated de-identification tool was developed and evaluated on different types of medical reports natively and after adapting the algorithm to the text structure. Materials and Methods A semi-automated de-identification tool was developed and evaluated for its sensitivity and specificity in detecting sensitive content in written reports. Data from 4671 pathology reports (4105 + 566 in two different formats), 2804 medical reports, 1008 operation reports, and 6223 radiology reports of 1167 patients suffering from breast cancer were de-identified. The content was itemized into four categories: direct identifiers (name, address), indirect identifiers (date of birth/operation, medical ID, etc.), medical terms, and filler words. The software was tested natively (without training) in order to establish a baseline. The reports were manually edited and the model re-trained for the next test set. After manually editing 25, 50, 100, 250, 500 and if applicable 1000 reports of each type re-training was applied. Results In the native test, 61.3 % of direct and 80.8 % of the indirect identifiers were detected. The performance (P) increased to 91.4 % (P25), 96.7 % (P50), 99.5 % (P100), 99.6 % (P250), 99.7 % (P500) and 100 % (P1000) for direct identifiers and to 93.2 % (P25), 97.9 % (P50), 97.2 % (P100), 98.9 % (P250), 99.0 % (P500) and 99.3 % (P1000) for indirect identifiers. Without training, 5.3 % of medical terms were falsely flagged as critical data. The performance increased, after training, to 4.0 % (P25), 3.6 % (P50), 4.0 % (P100), 3.7 % (P250), 4.3 % (P500), and 3.1 % (P1000). Roughly 0.1 % of filler words were falsely flagged. Conclusion Training of the developed de-identification tool continuously improved its performance. Training with roughly 100 edited reports enables reliable detection and labeling of sensitive data in different types of medical reports. Key Points: · Collaborations between different institutions require de-identification of patients' data. · Software-based de-identification of content-sensitive reports grows in importance as a result of 'Big data'. · A de-identification software was developed and tested natively and after training. · The proposed de-identification software worked quite reliably, following training with roughly 100 edited reports. · A final check of the texts by an authorized person remains necessary. Citation Format · Seuss H, Dankerl P, Ihle M et al. Semi-automated De-identification of German Content Sensitive Reports for Big Data Analytics. Fortschr Röntgenstr 2017; 189: 661 - 671.
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Semi-automated delineation of breast cancer tumors and subsequent materialization using three-dimensional printing (rapid prototyping) - Schulz-Wendtland, Rüdiger; Harz, Markus; Meier-Meitinger, Martina; Brehm, Barbara; Wacker, Till; Hahn, Horst K.; Wagner, Florian; Wittenberg, Thomas; Beckmann, Matthias; Uder, Michael; Fasching, Peter; Emons, Julius (Journal of Surgical Oncology, 2017)
Three-dimensional (3D) printing has become widely available, and a few cases of its use in clinical practice have been described. The aim of this study was to explore facilities for the semi-automated delineation of breast cancer tumors and to assess the feasibility of 3D printing of breast cancer tumors.In a case series of five patients, different 3D imaging methods-magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and 3D ultrasound-were used to capture 3D data for breast cancer tumors. The volumes of the breast tumors were calculated to assess the comparability of the breast tumor models, and the MRI information was used to render models on a commercially available 3D printer to materialize the tumors.The tumor volumes calculated from the different 3D methods appeared to be comparable. Tumor models with volumes between 325 mm(3) and 7,770 mm(3) were printed and compared with the models rendered from MRI. The materialization of the tumors reflected the computer models of them.3D printing (rapid prototyping) appears to be feasible. Scenarios for the clinical use of the technology might include presenting the model to the surgeon to provide a better understanding of the tumor's spatial characteristics in the breast, in order to improve decision-making in relation to neoadjuvant chemotherapy or surgical approaches. J. Surg. Oncol. 2017;115:238-242. © 2016 Wiley Periodicals, Inc.
EVALuna2:14618

Semi-Automatic Algorithm for Breast MRI Lesion Segmentation Using Marker-Controlled Watershed Transformation - Vesal, Sulaiman; Diaz-Pinto, Andres; Ravikumar, Nishant; Ellmann, Stephan; Davari, Amirabbas; Maier, Andreas (2017 IEEE Nuclear Science Symposium and Medical Imaging Conference Record (NSS/MIC), 2017)
UnivIS-Import:2018-09-11:Pub.2017.tech.IMMD.IMMD5.semiau_5

Semiautomatic segmentation of the kidney in magnetic resonance images using unimodal thresholding - Sandmair, Martin; Hammon, Matthias; Seuss, Hannes; Theis, Ragnar; Uder, Michael; Janka, Rolf Matthias (BMC Research Notes, 2016)
Total kidney volume (TKV) is an important marker for the presence or progression of chronic kidney disease, however, routine ultrasonography underestimates renal volume to a high and varying degree.The aim of this work was to adapt and evaluate a semi-automatic unimodal thresholding method for volumetric analysis of the kidney in native T2-weighted magnetic resonance (MR) images.In a group of healthy volunteers (n = 24; 48 kidneys), we defined a region of interest (ROI) by manually tracing the outline of the kidney in every MR image. An automatic unimodal thresholding algorithm with visual feedback was applied to the probability distribution function of voxel intensities in the ROI to remove intrarenal non-parenchyma volume. For comparison, reference volumes were created by manual segmentation. Intra- and inter-observer reliability was evaluated.There was a small, significant mean difference of 1.5 ml between semi-automatically and manually segmented TKV (p = 0.009, 95% CI [0.4, 2.7]). While intra-observer reliability was good (mean difference 2.9 ml, p < 0.01, 95% CI [1.5, 4.2]) there was a small but significant mean difference of 4.8 ml (p < 0.01, 95% CI [3.6, 5.9]) between the TKV results of different observers. Reference volume correlations were excellent (r = 0.97-0.98). Semi-automated segmentation was significantly faster than manual segmentation; mean difference = 234 s [91-483 s]; p < 0.05. Automatic unimodal thresholding removed a considerable mean volume of 18.7 ml (13.1%) from the coarse manual pre-segmentations.Unimodal thresholding of native MR images is a robust and sufficiently reliable method for kidney segmentation and volumetric analysis. The manual pre-segmentation can be done by non-experts with little introduction.
EVALuna2:14594

Semi-quantitative MRI biomarkers of knee osteoarthritis progression in the FNIH biomarkers consortium cohort - Methodologic aspects and definition of change - Roemer, Frank; Guermazi, Ali; Collins, Jamie E.; Losina, Elena; Nevitt, Michael C.; Lynch, John A.; Katz, Jeffrey N.; Kwoh, C. Kent; Kraus, Virginia B.; Hunter, David J. (BMC Musculoskeletal Disorders, 2016)
To describe the scoring methodology and MRI assessments used to evaluate the cross-sectional features observed in cases and controls, to define change over time for different MRI features, and to report the extent of changes over a 24-month period in the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium study nested within the larger Osteoarthritis Initiative (OAI) Study.We conducted a nested case-control study. Cases (n = 406) were knees having both radiographic and pain progression. Controls (n = 194) were knee osteoarthritis subjects who did not meet the case definition. Groups were matched for Kellgren-Lawrence grade and body mass index. MRIs were acquired using 3 T MRI systems and assessed using the semi-quantitative MOAKS system. MRIs were read at baseline and 24 months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. We provide the definition and distribution of change in these biomarkers over time.Seventy-three percent of the cases had subregions with BML worsening (vs. 66 % in controls) (p = 0.102). Little change in osteophytes was seen over 24 months. Twenty-eight percent of cases and 10 % of controls had worsening in meniscal scores in at least one subregion (p < 0.001). Seventy-three percent of cases and 53 % of controls had at least one area with worsening in cartilage surface area (p < 0.001). More cases experienced worsening in Hoffa- and effusion synovitis than controls (17 % vs. 6 % (p < 0.001); 41 % vs. 18 % (p < 0.001), respectively).A wide range of MRI-detected structural pathologies was present in the FNIH cohort. More severe changes, especially for BMLs, cartilage and meniscal damage, were detected primarily among the case group suggesting that early changes in multiple structural domains are associated with radiographic worsening and symptomatic progression.
EVALuna2:14637

Serelaxin activates eNOS, suppresses inflammation, attenuates developmental delay and improves cognitive functions of neonatal rats after germinal matrix hemorrhage - Xu, Ming M.; Seyler, L.; Bäuerle, Tobias; Kalinichenko, Liubov; Müller, Christian P.; Huttner, Hagen; Schwab, Stefan; Manaenko, A. (Scientific Reports, 2020)
Germinal matrix hemorrhage (GMH) is a detrimental form of neonatal CNS injury. Following GMH-mediated eNOS inhibition, inflammation arises, contributing to GMH-induced brain injury. We investigated the beneficial effects of Serelaxin, a clinical tested recombinant Relaxin-2 protein, on brain injury after GMH in rats. We investigated whether effects of Serelaxin are mediated by its ability to activate the GMH-suppressed eNOS pathway resulting in attenuation of inflammatory marker overproduction. GMH was induced by intraparenchymal injection of bacterial collagenase (0.3U). Seven day old Sprague–Dawley rat pups (P7) were used (n = 63). GMH animals were divided in vehicle or serelaxin treated (3 µg once, 30 µg once, 30 µg multiple, i.p., starting 30 after GMH and then daily). Sham operated animals were used. We monitored the developmental profile working memory and spatial function (T-maze and open field test respectively). At day 28, all rats underwent MRI-scans for assessment of changes in cortical thickness and white matter loss. Effects of Serelaxin on eNOS pathway activation and post-GMH inflammation were evaluated. We demonstrated that Serelaxin dose-dependently attenuated GMH-induced developmental delay, protected brain and improved cognitive functions of rats after GMH. That was associated with the decreased post-GMH inflammation, mediated at least partly by amelioration of GMH-induced eNOS inhibition.
CRIS-Team Scopus Importer:2020-05-29

Serum miRNAs Support the Indication for MRI-Ultrasound Fusion-Guided Biopsy of the Prostate in Patients with Low-PI-RADS Lesions - Keck, Bastian; Borkowetz, Angelika; Pöllmann, Julia; Jansen, Thilo; Fischer, Moritz; Fuessel, Susanne; Kahlmeyer, Andreas; Wirth, Manfred; Huber, Johannes; Cavallaro, Alexander Josef; Hammon, Matthias; Platzek, Ivan; et al. (Cells, 2021)
Multiparametric MRI (mpMRI) and targeted biopsy of the prostate enhance the tumor detection rate. However, the prediction of clinically significant prostate cancer (PCa) is still limited. Our study tested the additional value of serum levels of selected miRNAs in combination with clinical and mpMRI information for PCa prediction and classification. A total of 289 patients underwent targeted mpMRI-ultrasound fusion-guided prostate biopsy complemented by systematic biopsy. Serum miRNA levels of miRNAs (miR-141, miR-375, miR-21-5p, miR-320b, miR-210-3p, let-7c, and miR-486) were determined by quantitative PCR. Detection of any PCa and of significant PCa were the outcome variables. The patient age, pre-biopsy PSA level, previous biopsy procedure, PI-RADS score, and serum miRNA levels were covariates for regularized binary logistic regression models. The addition of miRNA expression of miR-486 and let-7c to the baseline model, containing only clinical parameters, increased the predictive accuracy. Particularly in patients with PI-RADS ≤3, we determined a sensitivity for detecting significant PCa (Gleason score ≥ 7a corresponding to Grade group ≥2) of 95.2%, and an NPV for absence of significant PCa of 97.1%. This accuracy could be useful to support patient counseling in selected cases.
CRIS-Team Scopus Importer:2021-06-18
Keywords: diagnosis; microRNA; miRNA; mpMRI; PI-RADS; prostate biopsy; prostate cancer

Severe radiographic knee osteoarthritis - does Kellgren and Lawrence grade 4 represent end stage disease? - the MOST study - Guermazi, Ali; Hayashi, D.; Roemer, Frank; Felson, D. T.; Wang, K.; Lynch, John; Amin, S.; Torner, J.; Lewis, C. E.; Nevitt, M. C. (Osteoarthritis and Cartilage, 2015)
To determine what MRI-detectable osteoarthritis features that are not visualized on radiography demonstrate progression longitudinally in Kellgren and Lawrence (KL) grade 4 knees.We studied subjects from the Multicenter Osteoarthritis Study who had KL grade 4 knees at baseline and had baseline and 30-month MRI. Cartilage damage, bone marrow lesions (BMLs), meniscal damage, synovitis (signal changes in Hoffa fat pad), and effusion (fluid equivalent signal in the joint cavity) were semiquantitatively scored using the Whole Organ MRI Score (WORMS) system in five subregions of the medial and lateral tibiofemoral (TF) compartments. Analysis was performed for the compartment showing bone-on-bone appearance ("index") on radiograph and also for the other TF compartment of the same knee. Synovitis and effusion were assessed for the whole knee. Changes in scores at follow-up were noted for each feature. For cartilage and BML, within-grade changes were also recorded.140 subjects (164 knees) were included (50% women, mean age 66.0 ± 8.6 years, mean BMI 30.4 ± 5.1 kg/m(2)). Longitudinally, 51 index compartments (34%) showed an increase in the sum of cartilage scores from all subregions. In the other compartment, 25% showed an increase in the sum score for cartilage damage. For BMLs in the index compartment, 50 knees (33%) showed an increase in maximum score and 32 (21%) showed a decrease. Meniscal status mostly remained stable. Effusion worsened in 36 knees (25%) and improved in 13 knees (9%). Synovitis worsened in 14 knees (10%) and improved in six knees (4%).In KL grade 4 knees, MRI-detected cartilage loss and fluctuation of BMLs, effusion, and synovitis occurred frequently over a 30-month period.
EVALuna2:14526

Severity assessment in maximally treated ICH patients: The max-ICH score - Sembill, Jochen; Gerner, Stefan; Volbers, Bastian; Bobinger, Tobias; Lücking, Hannes; Kloska, Stephan; Schwab, Stefan; Huttner, Hagen; Kuramatsu, Joji (Neurology, 2017)
As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool.This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models.Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0-3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61-0.73 vs AUC 0.80, CI 0.76-0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0-10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 months: AUC 0.81, CI 0.77-0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471).Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.
EVALuna2:22564

Sex differences in perihemorrhagic edema evolution after spontaneous intracerebral hemorrhage - Wagner, Irina; Volbers, Bastian; Kloska, Stephan; Schwab, Stefan; Staykov, Dimitre; Dörfler, Arnd (European Journal of Neurology, 2012)
Background and purpose: Clinical data on sex differences in perihemorrhagic edema (PHE) after intracerebral hemorrhage (ICH) are lacking. Methods: Patients with spontaneous supratentorial ICH who had received standard conservative treatment were identified retrospectively. PHE development was assessed over a 14-day period on follow-up CT scans (days 1, 2-4, 5-7, 8-11, and 12-14). ICH and PHE volumes were assessed semiautomatically and compared between men and women. Results: A total of 387 patients (233 men) were included. Starting at days 2-4, women showed lower PHE values (P<0.05;/ days 2-4, 8-11) or a trend toward significance (P≤0.1; days 5-7, 12-14). Conclusions: Female sex may predict lower PHE volumes. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Gender; Intracerebral hemorrhage; Perihemorrhagic edema

Sex-Specific Influence of Quadriceps Weakness on Worsening Patellofemoral and Tibiofemoral Cartilage Damage: A Prospective Cohort Study - Culvenor, Adam G.; Segal, Neil A.; Guermazi, Ali; Roemer, Frank; Felson, David T.; Nevitt, Michael C.; Lewis, Cora E.; Stefanik, Joshua J. (Arthritis & Rheumatism-Arthritis Care & Research, 2019)
Objective Reports on quadriceps weakness as a risk factor for incident and progressive knee osteoarthritis are conflicting, potentially due to differing effects of muscle strength on patellofemoral and tibiofemoral compartments. This study aimed to examine the sex-specific relation of quadriceps strength to worsening patellofemoral and tibiofemoral cartilage damage over 84 months. Methods The Multicenter Osteoarthritis Study is a cohort study of individuals with or at risk for knee osteoarthritis. Maximal quadriceps strength was assessed at baseline. Cartilage damage was semiquantitatively assessed by magnetic resonance imaging at baseline and 84-month follow-up using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Worsening patellofemoral and tibiofemoral cartilage damage was defined as any WORMS score increase in each subregion within medial and lateral compartments separately. Logistic regression with generalized estimating equations was used to assess the sex-specific relation of quadriceps strength to worsening cartilage damage. Results A total of 1,018 participants (mean +/- SD age 61 +/- 8 years, and mean +/- SD body mass index 29.3 +/- 4.5 kg/m(2); 64% female) were included. Quadriceps weakness increased the risk of worsening lateral patellofemoral cartilage damage in women (risk ratio for lowest versus highest quartile of strength 1.50 [95% confidence interval 1.03-2.20]; P = 0.007 for linear trend) but not in men. There was generally no association between quadriceps weakness and worsening cartilage damage in the medial or lateral tibiofemoral compartment for either women or men. Conclusion Low quadriceps strength increased the risk of worsening cartilage damage in the lateral patellofemoral joint of women, suggesting that optimizing quadriceps strength may help prevent worsening of structural damage in the patellofemoral joint in women.
CRIS-Team WoS Importer:2019-10-18

SGLT-2-inhibition with dapagliflozin reduces tissue sodium content: a randomised controlled trial - Karg, Margarete; Bosch, A.; Kannenkeril, D.; Striepe, Kristina; Ott, Christian; Schneider, M. P.; Boemke-Zelch, Franziska; Linz, Peter; Nagel, Armin Michael; Titze, Jens; Uder, Michael; Schmieder, Roland (Cardiovascular Diabetology, 2018)
Sodium tissue content by 23Na magnetic resonance imaging (Na-MRI) has been validated in experimental and human studies. SGLT-2 inhibition blocks the reabsorption of glucose and of sodium in the proximal tubular cells in a 1:1 fashion. We hypothesized that SGLT-2 inhibition in patients with type 2 diabetes characterized by sodium retention leads to decreased tissue sodium content due to its pharmacological action.In a prospective double blind, placebo controlled, cross-over trial 59 patients (61 ± 7.6 years) with type 2 diabetes were randomized to either dapagliflozin 10 mg or placebo once daily for 6 weeks each. In addition to metabolic parameters and ambulatory blood pressure (BP) we analysed the sodium content in the skin and muscles of the lower leg by Na-MRI.Compared to baseline 6 weeks treatment with the SGLT-2 inhibitor dapagliflozin decreased fasting (132 ± 28 vs. 114 ± 19 mg/dl, p < 0.001), postprandial blood glucose (178 ± 66 mg/dl vs. 153 ± 46 mg/dl, p < 0.001), body weight (87.6 vs. 86.6 kg, p < 0.001) and systolic (129 ± 12 vs. 126 ± 11 mmHg, p = 0.010), and diastolic (77.4 ± 9 vs. 75.6 ± 8 mmHg, p = 0.024), 24-h ambulatory BP. Tissue sodium content in the skin was reduced after 6 weeks treatment with dapagliflozin compared to baseline [24.1 ± 6.6 vs. 22.7 ± 6.4 A.U.(arbitrary unit) p = 0.013]. No significant reduction of tissue sodium content was observed in the muscle (M. triceps surae: 20.5 ± 3.5 vs. 20.4 ± 3.7 A.U. p = 0.801). No clear significant difference in tissue water content of muscle and skin was observed after 6 weeks of treatment with dapagliflozin, compared to baseline.SGLT-2 inhibition with dapagliflozin resulted in a significant decrease in tissue sodium content of the skin after 6 weeks. This observation point to a decrease of total sodium content in patients with type 2 diabetes prone to cardiovascular complications, that might be mitigated by SGLT-2 inhibition. Trial registration The study was registered at http://www.clinicaltrials.gov (NCT02383238) retrospectively registered.
EVALuna2:4043

Sidebands in CEST MR—How to recognize and avoid them - Schüre, Jan-Rüdiger; Weinmüller, Simon; Kamm, Lukas; Herz, Kai; Zaiß, Moritz (Magnetic Resonance in Medicine, 2024)
Purpose: Clinical scanners require pulsed CEST sequences to maintain amplifier and specific absorption rate limits. During off-resonant RF irradiation and interpulse delay, the magnetization can accumulate specific relative phases within the pulse train. In this work, we show that these phases are important to consider, as they can lead to unexpected artifacts when no interpulse gradient spoiling is performed during the saturation train. Methods: We investigated sideband artifacts using a CEST-3D snapshot gradient-echo sequence at 3 T. Initially, Bloch-McConnell simulations were carried out with Pulseq-CEST, while measurements were performed in vitro and in vivo. Results: Sidebands can be hidden in Z-spectra, and their structure becomes clearly visible only at high sampling. Sidebands are further influenced by B0 inhomogeneities and the RF phase cycling within the pulse train. In vivo, sidebands are mostly visible in liquid compartments such as CSF. Multi-pulse sidebands can be suppressed by interpulse gradient spoiling. Conclusion: We provide new insights into sidebands occurring in pulsed CEST experiments and show that, similar as in imaging sequences, gradient and RF spoiling play an important role. Gradient spoiling avoids misinterpretations of sidebands as CEST effects especially in liquid environments including pathological tissue or for CEST resonances close to water. It is recommended to simulate pulsed CEST sequences in advance to avoid artifacts.
CRIS-Team Scopus Importer:2024-02-16
Keywords: artifacts; CEST; gradient spoiling; phase-cycling; pulsed CEST imaging; pulseq-CEST; sidebands

Siglec-15 on osteoclasts is crucial for bone erosion in serum-Transfer arthritis - Korn, Marina; Schmitt, Heike; Angermüller, Sieglinde; Chambers, David; Seeling, Michaela; Lux, Uwe; Brey, Stefanie; Royzman, Dmytro; Bruckner, Christin; Popp, Vanessa; Percivalle, Elena; Bäuerle, Tobias; et al. (Journal of Immunology, 2020)
Siglec-15 is a conserved sialic acid binding Ig-like lectin, which is expressed on osteoclasts. Deficiency of Siglec-15 leads to an impaired osteoclast development, resulting in a mild osteopetrotic phenotype. The role of Siglec-15 in arthritis is still largely unclear. To address this, we generated Siglec-15 knockout mice and analyzed them in a mouse arthritis model.We could show that Siglec-15 is directly involved in pathologic bone erosion in the K/BxN serum-Transfer arthritis model. Histological analyses of joint destruction provided evidence for a significant reduction in bone erosion area and osteoclast numbers in Siglec-152/2 mice, whereas the inflammation area and cartilage destruction was comparable to wild-Type mice. Thus, Siglec-15 on osteoclasts has a crucial function for bone erosion during arthritis. In addition, we generated a new monoclonal anti Siglec-15 Ab to clarify its expression pattern on immune cells. Whereas this Ab demonstrated an almost exclusive Siglec-15 expression on murine osteoclasts and hardly any other expression on various other immune cell types, human Siglec-15 was more broadly expressed on human myeloid cells, including human osteoclasts. Taken together, our findings show a role of Siglec-15 as a regulator of pathologic bone resorption in arthritis and highlight its potential as a target for future therapies, as Siglec-15 blocking Abs are available.
CRIS-Team Scopus Importer:2020-11-20

Signal decomposition for X-ray dark-field imaging - Käppler, Sebastian; Bayer, Florian; Weber, Thomas; Maier, Andreas; Anton, Gisela; Hornegger, Joachim; Beckmann, Matthias; Fasching, Peter; Hartmann, Arndt; Heindl, Felix; Michel, Thilo; Oezguel, Gueluemser; et al. (MICCAI 2014, 2014)
Grating-based X-ray dark-field imaging is a new imaging modality. It allows the visualization of structures at micrometer scale due to small-angle scattering of the X-ray beam. However, reading darkfield images is challenging as absorption and edge-diffraction effects also contribute to the dark-field signal, without adding diagnostic value. In this paper, we present a novel–and to our knowledge the first–algorithm for isolating small-angle scattering in dark-field images, which greatly improves their interpretability. To this end, our algorithm utilizes the information available from the absorption and differential phase images to identify clinically irrelevant contributions to the dark-field image. Experimental results on phantom and ex-vivo breast data promise a greatly enhanced diagnostic value of dark-field image
EVALuna2:6632

Significance of preradiographic magnetic resonance imaging lesions in persons at increased risk of knee osteoarthritis - Sharma, Leena; Chmiel, Joan S.; Almagor, Orit; Dunlop, Dorothy; Guermazi, Ali; Bathon, Joan M.; Eaton, Charles B.; Hochberg, Marc C.; Jackson, Rebecca D.; Kwoh, C. Kent; Mysiw, W. Jerry; Crema, Michel D.; et al. (Arthritis and Rheumatology, 2014)
Little is known about early knee osteoarthritis (OA). The significance of lesions on magnetic resonance imaging (MRI) in older persons without radiographic OA is unclear. Our objectives were to determine the extent of tissue pathology by MRI and evaluate its significance by testing the following hypotheses: cartilage damage, bone marrow lesions, and meniscal damage are associated with prevalent frequent knee symptoms and incident persistent symptoms; bone marrow lesions and meniscal damage are associated with incident tibiofemoral (TF) cartilage damage; and bone marrow lesions are associated with incident patellofemoral (PF) cartilage damage.In a cohort study of 849 Osteoarthritis Initiative (OAI) participants who had a bilateral Kellgren/Lawrence (K/L) score of 0, we assessed cartilage damage, bone marrow lesions, and meniscal damage using the MRI OA Knee Score, as well as prevalent frequent knee symptoms, incident persistent symptoms, and incident cartilage damage. Multiple logistic regression (one knee per person) was used to evaluate associations between MRI lesions and each of these outcomes.Of the participants evaluated, 76% had cartilage damage, 61% had bone marrow lesions, 21% had meniscal tears, and 14% had meniscal extrusion. Cartilage damage (any; TF and PF), bone marrow lesions (any; TF and PF), meniscal extrusion, and body mass index (BMI) were associated with prevalent frequent symptoms. Cartilage damage (isolated PF; TF and PF), bone marrow lesions (any; isolated PF; TF and PF), meniscal tears, and BMI were associated with incident persistent symptoms. Hand OA, but no individual lesion type, was associated with incident TF cartilage damage, and bone marrow lesions (any; any PF) with incident PF damage. Having more lesion types was associated with a greater risk of outcomes.MRI-detected lesions are not incidental and may represent early disease in persons at increased risk of knee OA.
EVALuna2:14574

Significant Suppression of CT Radiation-Induced DNA Damage in Normal Human Cells by the PrC-210 Radioprotector - Jermusek, Frank; Benedict, Chelsea; Dreischmeier, Emma; Brand, Michael; Uder, Michael; Jeffery, Justin J.; Ranallo, Frank N.; Fahl, William E. (Radiation Research, 2018)
While computed tomography (CT) is now commonly used and considered to be clinically valuable, significant DNA double-strand breaks (γ-H2AX foci) in white blood cells from adult and pediatric CT patients have been frequently reported. In this study to determine whether γ-H2AX foci and X-ray-induced naked DNA damage are suppressed by administration of the PrC-210 radioprotector, human blood samples were irradiated in a CT scanner at 50-150 mGy with or without PrC-210, and γ-H2AX foci were scored. X-ray-induced naked DNA damage was also studied, and the DNA protective efficacy of PrC-210 was compared against 12 other common "antioxidants." PrC-210 reduced CT radiation-induced γ-H2AX foci in white blood cells to near background ( P < 0.0001) at radiation doses of 50-150 mGy. PrC-210 was most effective among the 13 "antioxidants" in reducing naked DNA X-ray damage, and its addition at 30 s before an •OH pulse reduced to background the •OH insult that otherwise induced >95% DNA damage. A systemic PrC-210 dose known to confer 100% survival in irradiated mice had no discernible effect on micro-CT image signal-to-noise ratio and CT image integrity. PrC-210 suppressed DNA damage to background or near background in each of these assay systems, thus supporting its development as a radioprotector for humans in multiple radiation exposure settings.
EVALuna2:34691

Simplified Edinburgh CT Criteria for Identification of Lobar Intracerebral Hemorrhage Associated With Cerebral Amyloid Angiopathy - Sembill, Jochen; Knott, Michael; Xu, Mingming; Röder, Sebastian; Hagen, Manuel; Sprügel, Maximilian; Mrochen, Anne; Borutta, Matthias; Hölter, Philip; Engelhorn, Tobias Martin; Rothhammer, Veit; Macha, Kosmas; et al. (Neurology, 2022)
BACKGROUND AND OBJECTIVES: In patients with lobar intracerebral hemorrhage (ICH), etiologic characterization represents a tradeoff between feasibility, resource allocation, and diagnostic certainty. This study investigated the accuracy and clinical utility of the simplified Edinburgh CT criteria to identify underlying cerebral amyloid angiopathy (CAA). METHODS: This external validation analyzed 210 consecutive patients with lobar ICH and available CT and MRI studies from a prospective single-center observational cohort study (2006-2015, Longitudinal Cohort Study on ICH Care [UKER-ICH,] NCT03183167). We investigated the interrater variability and diagnostic accuracy of the simplified Edinburgh CT-based criteria for identification of ICH associated with probable CAA according to MRI-based modified Boston criteria as a reference standard. We evaluated the utility of the simplified Edinburgh criteria by decision curve analysis, comparing the theoretical clinical net benefit (weighted benefit-harm at varying threshold probabilities) of the high-risk category (finger-like projections and subarachnoid hemorrhage) for ruling in and the low-risk category (neither finger-like projections nor subarachnoid hemorrhage) for ruling out with the assumptions of no or all patients having CAA (default strategies). RESULTS: Of 210 patients, 70 (33.3%) had high risk, 67 (31.9%) had medium risk, and 73 (34.8%) had low risk for CAA-associated ICH according to simplified Edinburgh CT criteria, showing moderate interrater variability. Discrimination was good (area under the receiver operating characteristics curve 0.74, 95% CI 0.67-0.81) without evidence of poor calibration (Hosmer-Lemeshow, p = 0.54) for validation of MRI-based diagnosis of probable CAA (n = 94 of 210, 44.8%). The rule-in criteria (high risk), had 87.1% (79.3%-92.3%) specificity, and the rule-out criteria (low risk), had 80.9% (71.1%-88.0%) sensitivity. Decision curve analysis suggested a theoretical clinical net benefit for ruling in but not for ruling out probable CAA compared to default strategies. DISCUSSION: Applying the simplified Edinburgh CT criteria during diagnostic workup seems clinically useful and may accurately identify CAA in patients with lobar ICH. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT03183167. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with lobar hemorrhages, the simplified Edinburgh criteria accurately identify those at high risk of CAA.
CRIS-Team Scopus Importer:2022-06-03

Simultaneous dynamic glucose-enhanced (DGE) MRI and fiber photometry measurements of glucose in the healthy mouse brain - Eleftheriou, Afroditi; Ravotto, Luca; Wyss, Matthias T.; Warnock, Geoffrey; Siebert, Anita; Zaiß, Moritz; Weber, Bruno (NeuroImage, 2023)
Glucose is the main energy source in the brain and its regulated uptake and utilization are important biomarkers of pathological brain function. Glucose Chemical Exchange Saturation Transfer (GlucoCEST) and its time-resolved version Dynamic Glucose-Enhanced MRI (DGE) are promising approaches to monitor glucose and detect tumors, since they are radioactivity-free, do not require 13C labeling and are is easily translatable to the clinics. The main principle of DGE is clear. However, what remains to be established is to which extent the signal reflects vascular, extracellular or intracellular glucose. To elucidate the compartmental contributions to the DGE signal, we coupled it with FRET-based fiber photometry of genetically encoded sensors, a technique that combines quantitative glucose readout with cellular specificity. The glucose sensor FLIIP was used with fiber photometry to measure astrocytic and neuronal glucose changes upon injection of D-glucose, 3OMG and L-glucose, in the anaesthetized murine brain. By correlating the kinetic profiles of the techniques, we demonstrate the presence of a vascular contribution to the signal, especially at early time points after injection. Furthermore, we show that, in the case of the commonly used contrast agent 3OMG, the DGE signal actually anticorrelates with the glucose concentration in neurons and astrocytes.
CRIS-Team Scopus Importer:2022-12-30
Keywords: Fiber photometry; Genetically encoded sensors; Glucocest; Kinetic modeling; Two-photon microscopy

Simultaneous Multislice Echo Planar Imaging for Accelerated Diffusion-Weighted Imaging of Malignant and Benign Breast Lesions - Ohlmeyer, Sabine; Palm, Theresa; Janka, Rolf Matthias; Weiland, Elisabeth; Uder, Michael; Wenkel, Evelyn; Laun, Frederik Bernd (Investigative Radiology, 2019)
Objectives Comparison of the diagnostic value of simultaneous multislice (SMS) accelerated diffusion-weighted echo planar imaging (EPI) of malignant and benign lesions of the breast compared with a reference EPI sequence. Materials and Methods The study was approved by the institutional ethics committee. Sixty-eight patients were examined with a diffusion-weighted EPI (reference EPI; TE = 54 milliseconds; TR = 9000 milliseconds; TA, 3:27 minutes) and a diffusion-weighted SMS accelerated EPI (SMS EPI; acceleration factor 2; TE = 58 milliseconds; TR = 4300 milliseconds; TA, 1:53 minutes) in addition to the standard magnetic resonance imaging (MRI) protocol. Further acquisition parameters were as follows: 3 T MAGNETOM Skyra (Siemens Healthcare, Erlangen, Germany), 2.5-mm isotropic resolution, field of view = 185 to 190 × 350 mm2, 62 slices, b = 50 and 800 s/mm2 with 1 and 4 averages, respectively. A dedicated 16-channel bilateral breast coil was used for imaging. Image quality was evaluated with respect to the presence of artifacts, signal voids, and quality of fat suppression. These parameters were rated using a 5-point Likert scale (1 = very strong to 5 = negligible). The apparent diffusion coefficient (ADC) was measured in 72 focal lesions (46 breast carcinomas and 26 benign lesions), and the diagnostic value of the 2 datasets was statistically evaluated and compared. The evaluation was performed a second time excluding cysts. Results Artifacts and signal voids were negligible in both sequences (mean on Likert scale for reference EPI 4.68 vs SMS EPI 4.65, P = 0.52, and mean on Likert scale for reference EPI 4.85 vs SMS EPI 4.77, P = 0.14). Fat suppression was significantly better in SMS EPI (mean on Likert scale 3.28 vs 2.97, P < 0.001, Pearson r = 0.49). For benign lesions, the mean ADC in both EPI sequences was 1.86 · 10-3 mm2/s. For malignant lesions, a mean ADC of 0.90 · 10-3 mm2/s for the reference EPI and 0.89 · 10-3 mm2/s for the SMS EPI was found. No significant difference between the EPI sequences was observed for ADC values (P = 0.75) and for the area under the curve (SMS, 0.985; no SMS, 0.975). The cutoff for differentiation of benign and malignant lesions was at ADC = 1.42 · 10-3 mm2/s for SMS EPI (sensitivity, 1; specificity, 0.88) and at 1.23 · 10-3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.92). Excluding the cysts, the cutoff for differentiation of benign and malignant lesions was at ADC = 1.11 · 10-3 mm2/s for SMS EPI (sensitivity, 0.89; specificity, 0.93) and at 1.23 · 10-3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.87). Conclusions Our data indicate that SMS acceleration can be used for diffusion imaging in breast MRI in clinical practice. Simultaneous multislice EPI achieved the same diagnostic accuracy in breast MRI, but in a substantially reduced scan time.
CRIS-Team Scopus Importer:2019-07-26
Keywords: breast; diffusion; DW MRI; DWI; EPI; lesions; simultaneous multislice acceleration; SMS

Single-cycle induction chemotherapy followed by chemoradiotherapy or surgery in patients with head and neck cancer: What are the best predictors of remission and prognosis? - Semrau, Sabine; Haderlein, Marlen; Schmidt, Daniela; Lell, Michael; Wolf, Walburga; Waldfahrer, Frank; Uder, Michael; Iro, Heinrich; Kuwert, Torsten; Fietkau, Rainer (Cancer, 2015)
There is controversy over the concept of function and organ preservation by chemotherapy/chemoradiation instead of surgery in locally advanced cancer of the larynx or pharynx. Tumor response to induction chemotherapy (ICT) can help in choosing between conservative and surgical treatment. This study compared 3 methods of assessing response to ICT: endoscopy, computed tomography, and (18) F-FDG-PET/CT.Primary response to 1 cycle of ICT with docetaxel plus platinum was assessed by the aforementioned methods in 62 laryngopharyngeal cancer patients. Endoscopic response was the deciding factor for selecting further treatment: surgery for endoscopic nonresponders (<30% tumor response) versus chemoradiotherapy for endoscopic responders.ICT achieved endoscopic response in 48 of 62 patients (77%). Individual relative residual tumor activity of standardized uptake value (resSUVmax ) in (18) F-FDG-PET/CT was a median 0.38 of baseline (0.09-1.71), whereas residual tumor extent in CT (resCT) was 0.75 of baseline (0.32-1.20). Endoscopic responders and nonresponders differed significantly in SUVmax after ICT (postSUVmax , 6.0 vs 14.5; P < .001), resSUVmax (0.34 vs 0.81, P < .001), and resCT (0.71 vs 0.87, P = .004), but not in maximum tumor diameter after ICT (14 vs 20 mm, P = .11). resSUVmax <0.8 and absolute postSUVmax <10 provided the best discriminatory power for long-term success criteria (tumor-free survival, overall survival).Metabolic tumor response showed very good correlation with clinical tumor response to ICT. The value of metabolic response detected by (18) F-FDG-PET/CT should be explored in a prospective clinical trial. Cancer 2015;121:1214-1222. © 2014 American Cancer Society.
EVALuna2:13821

Single source split filter dual energy: Image quality and liver lesion detection in abdominal CT - Eichler, Mathis; May, Matthias; Wiesmüller, Marco; Saake, Marc; Heiß, Rafael; Uder, Michael; Wüst, Wolfgang (European Journal of Radiology, 2020)
Purpose: Aim of this study was to evaluate image quality of single source dual energy CT (SSDE-CT) using split filter technique in oncologic abdominal CT. Method: 51 consecutive patients with newly diagnosed breast carcinoma were prospectively enrolled in this study and underwent a staging examination of the abdomen using SSDE-CT (120 kV, split filter technique, 400 ref. mAs). Inline default images (DI) and post-processed virtual monoenergetic images at 40 keV, 50 keV, 60 keV, 70 keV and 80 keV were reconstructed. Objective image quality was evaluated as contrast to noise ratio (CNR) for liver parenchyma, portal vein, spleen, pancreas, aorta and hypoattenuating liver lesions. Subjective image quality was rated on a 5-point scale. Image quality at different keV settings was analyzed in paired t-tests. Results: CNR was highest at 40 keV for vessels (portal vein: 9.0, aorta: 8.8, all p < 0.001) and for upper abdominal organs (spleen: 4.8, all p < 0.001; pancreas: 2.7, all p < 0.01 except p = 0.93 for 50 keV; liver parenchyma: 3.4, all p < 0.01). Highest CNR values for hypoattenuating liver lesions were found at 40 keV (7.7, all p < 0.001). Overall subjective image quality was highest with 80 keV and DI (both 4.8, all p < 0.001). Artifacts were most pronounced at 40 keV. Conclusions: High image quality can be obtained with SSDE-CT of the abdomen. Lowest monoenergetic reconstructions provide the highest image contrast and should be used for vessel evaluation. The best trade-off between artifacts and parenchymal contrast can be obtained with 80 keV images.
CRIS-Team Scopus Importer:2020-03-10
Keywords: Abdominal imaging; Breast carcinoma; Single source dual energy

Siponimod (BAF-312) Attenuates Perihemorrhagic Edema And Improves Survival in Experimental Intracerebral Hemorrhage - Bobinger, Tobias; Manaenko, Anatol; Burkardt, Petra; Beuscher, Vanessa; Sprügel, Maximilian; Röder, Sebastian; Bäuerle, Tobias; Seyler, Lisa; Nagel, Armin Michael; Linker, Ralf; Engelhorn, Tobias; Dörfler, Arnd; et al. (Stroke, 2019)
Background and Purpose- Perihemorrhagic edema (PHE) is associated with poor outcome after intracerebral hemorrhage (ICH). Infiltration of immune cells is considered a major contributor of PHE. Recent studies suggest that immunomodulation via S1PR (sphingosine-1-phosphate receptor) modulators improve outcome in ICH. Siponimod, a selective modulator of sphingosine 1-phosphate receptors type 1 and type 5, demonstrated an excellent safety profile in a large study of patients with multiple sclerosis. Here, we investigated the impact of siponimod treatment on perihemorrhagic edema, neurological deficits, and survival in a mouse model of ICH. Methods- ICH was induced by intracranial injection of 0.075 U of bacterial collagenase in 123 mice. Mice were randomly assigned to different treatment groups: vehicle, siponimod given as a single dosage 30 minutes after the operation or given 3× for 3 consecutive days starting 30 minutes after operation. The primary outcome of our study was evolution of PHE measured by magnetic resonance-imaging on T2-maps 72 hours after ICH, secondary outcomes included evolution of PHE 24 hours after ICH, survival and neurological deficits, as well as effects on circulating blood cells and body weight. Results- Siponimod significantly reduced PHE measured by magnetic resonance imaging (P=0.021) as well as wet-dry method (P=0.04) 72 hours after ICH. Evaluation of PHE 24 hours after ICH showed a tendency toward attenuated brain edema in the low-dosage group (P=0.08). Multiple treatments with siponimod significantly improved neurological deficits measured by Garcia Score (P=0.03). Survival at day 10 was improved in mice treated with multiple dosages of siponimod (P=0.037). Mice treated with siponimod showed a reduced weight loss after ICH (P=0.036). Conclusions- Siponimod (BAF-312) attenuated PHE after ICH, increased survival, and reduced ICH-induced sensorimotor deficits in our experimental ICH-model. Findings encourage further investigation of inflammatory modulators as well as the translation of BAF-312 to a human study of ICH patients.
EVALuna2:204480

Siponimod reduces perihemorrhagic edema and improves neurological outcome in experimental intracerebral hemorrhage - Bobinger, Tobias; Manaenko, A.; Baeurele, T.; Seyler, L.; Nagel, Armin Michael; Engelhorn, Tobias; Dörfler, Arnd; Kuramatsu, J. B.; Schwab, Stefan; Huttner, Hagen (JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2019)
CRIS-Team WoS Importer:2019-07-19

Site and size of multiple sclerosis lesions predict enhanced or decreased female orgasmic function - Winder, Klemens; Seifert, Frank; Koehn, Julia; Deutsch, Martina; Engelhorn, Tobias; Dörfler, Arnd; Lee, De-Hyung; Linker, Ralf; Hilz, Max-Josef (Journal of Neurology, 2015)
Neuroimaging identified brain areas involved in female orgasm. In women with multiple sclerosis (MS), associations between orgasmic function and the site and size of MS-related magnetic resonance imaging (MRI) changes are undetermined. This study intended to correlate MS-associated cerebral lesion load and location with clinical scores of female orgasmic function. In 50 women with MS (mean age 37.0 ± 9.9 years), we assessed Female Sexual Function Index (FSFI) scores for orgasmic frequency, difficulty and satisfaction. We determined disease duration, Expanded Disability Status Scale (EDSS) scores, and cerebral MS-lesion load and location using T2-weighed 1.5 T MRIs. We correlated FSFI scores for orgasm with patient age, disease duration, EDSS scores, and cerebral MS-lesion load (Spearman rank correlation; significance: p < 0.05). FSFI scores for orgasm correlated inversely with MS-lesion load in the left temporal periventricular white matter and right middle-inferior occipital area, but directly with MS-lesion load in the right frontal primary motor cortex, left prefrontal/inferior frontal cortex, right amygdala, left temporal middle-inferior and fusiform areas, and midbrain. FSFI scores for orgasm did not correlate with patient age, disease duration and EDSS scores (p > 0.05). In conclusion, our results indicate that MS-lesions in left temporal periventricular and right visual association areas deteriorate orgasmic function. In contrast, direct correlations between frontotemporal or midbrain lesions and higher FSFI scores, indicating enhanced or disinhibited orgasmic function, suggest that these brain regions normally buffer orgasmic responses. Moreover, our results indicate that orgasmic dysfunction in women with MS evolves independently of disease duration and physical disability.
EVALuna2:22361

SIZE MATTERS - EXTENT OF MONOSODIUM URATE DEPOSITS BUT NOT SERUM URATE LEVEL PREDICTS COMPLETE RESOLUTION OF MONOSODIUM URATE CRYSTAL DEPOSITS IN PATIENTS WITH GOUT - Bayat, Sara; Ellmann, Hanna; Guilhon de Araujo, Elizabeth; Manger, Bernhard; Hagen, Melanie; Kleyer, Arnd; Lell, Michael; Schenker, Hannah; Simon, David; Tascilar, Koray; Baraf, Herbert S. B.; Schett, Georg; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2019)
CRIS-Team WoS Importer:2019-07-12

Skin Sodium Accumulates in Psoriasis and Reflects Disease Severity - Maifeld, András; Wild, Johannes; Karlsen, Tine V.; Rakova, Natalia; Wistorf, Elisa; Linz, Peter; Jung, Rebecca; Birukov, Anna; Gimenez-Rivera, Vladimir Andrey; Wilck, Nicola; Bartolomaeus, Theda; Dechend, Ralf; et al. (Journal of Investigative Dermatology, 2021)
Sodium can accumulate in the skin at concentrations exceeding serum levels. A high sodium environment can lead to pathogenic T helper 17 cell expansion. Psoriasis is a chronic inflammatory skin disease in which IL-17‒producing T helper 17 cells play a crucial role. In an observational study, we measured skin sodium content in patients with psoriasis and in age-matched healthy controls by Sodium-23 magnetic resonance imaging. Patients with PASI > 5 showed significantly higher sodium and water content in the skin but not in other tissues than those with lower PASI or healthy controls. Skin sodium concentrations measured by Sodium-23 spectroscopy or by atomic absorption spectrometry in ashed-skin biopsies verified the findings with Sodium-23 magnetic resonance imaging. In vitro T helper 17 cell differentiation of naive CD4+ cells from patients with psoriasis markedly induced IL-17A expression under increased sodium chloride concentrations. The imiquimod-induced psoriasis mouse model replicated the human findings. Extracellular tracer Chromium-51–EDTA measurements in imiquimod- and sham-treated skin showed similar extracellular volumes, rendering excessive water of intracellular origin. Chronic genetic IL-17A‒driven psoriasis mouse models underlined the role of IL-17A in dermal sodium accumulation and inflammation. Our data describe skin sodium as a pathophysiological feature of psoriasis, which could open new avenues for its treatment.
CRIS-Team Scopus Importer:2021-08-13

Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD - Schneider, Markus P.; Raff, Ulrike; Kopp, Christoph; Scheppach, Johannes B.; Toncar, Sebastian; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Floege, Juergen; Schmid, Matthias; Birukov, Anna; Dahlmann, Anke; et al. (Journal of the American Society of Nephrology, 2017)
The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using (23)sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, P<0.001 versus r=0.35, P<0.001; P<0.01 between the two correlations). Linear regression analysis demonstrated that skin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients.
EVALuna2:3863

Skin sodium content as a predictor of blood pressure response to renal denervation - Günes-Altan, Merve; Schmid, Axel; Kannenkeril, Dennis; Linz, Peter; Ott, Christian; Bosch, Agnes; Schiffer, Mario; Uder, Michael; Schmieder, Roland (Hypertension Research, 2023)
Patients with treatment resistant hypertension (TRH) are known to have elevated sodium (Na) content in muscle and skin. Renal denervation (RDN) emerged as an adjacent therapeutic option in this group of patients. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN in patients with TRH. Radiofrequency-device based RDN was performed in 58 patients with uncontrolled TRH. Office and 24-h ambulatory BP were measured at baseline and after 6 months. To assess tissue Na content Na magnetic resonance imaging (Na-MRI) was performed at baseline prior to RDN. We splitted the study cohort into responders and non-responders based on the median of systolic 24-h ambulatory blood pressure (ABP) reduction after 6 months and evaluated the association between BP response to RDN and tissue Na content in skin and muscle. The study was registered at http://www.clinicaltrials.gov (NCT01687725). Six months after RDN 24-h ABP decreased by −8.6/−4.7 mmHg. BP-Responders were characterized by the following parameters: low tissue sodium content in the skin (p = 0.040), female gender (p = 0.027), intake of aldosterone antagonists (p = 0.032), high baseline 24-h night-time heart rate (p = 0.045) and high LDL cholesterol (p < 0.001). These results remained significant after adjustment for baseline 24-h systolic BP. Similar results were obtained when the median of day-time and night-time ABP reduction after 6 months were used as cut-off criteria for defining BP response to RDN. We conclude that in addition to clinical factors including baseline 24-h ABP Na-MRI may assist to select patients with uncontrolled TRH for RDN treatment. [Figure not available: see fulltext.].
CRIS-Team Scopus Importer:2023-11-03
Keywords: Renal denervation; Sodium MRI; Tissue sodium

Skin sodium is increased in male patients with multiple sclerosis and related animal models - Huhn, Konstantin; Linz, Peter; Pemsel, Franziska; Michalke, Bernhard; Seyferth, Stefan; Kopp, Christoph; Chaudri, Mohammad Anwar; Rothhammer, Veit; Dörfler, Arnd; Uder, Michael; Nagel, Armin M.; Müller, Dominik N.; et al. (Proceedings of the National Academy of Sciences of the United States of America, 2021)
Novel MRI techniques allow a noninvasive quantification of tissue sodium and reveal the skin as a prominent compartment of sodium storage in health and disease. Since multiple sclerosis (MS) immunopathology is initiated in the periphery and increased sodium concentrations induce proinflammatory immune cells, the skin represents a promising compartment linking high sodium concentrations and MS immunopathology. We used a 7-T sodium MRI (23Na-MRI) and inductively coupled plasma mass spectrometry to investigate the skin sodium content in two mouse models of MS. We additionally performed 3-T 23Na-MRI of calf skin and muscles in 29 male relapsing-remitting MS (RRMS) patients and 29 matched healthy controls. Demographic and clinical information was collected from interviews, and disease activity was assessed by expanded disability status scale scoring. 23Na-MRI and chemical analysis demonstrated a significantly increased sodium content in the skin during experimental autoimmune encephalomyelitis independent of active immunization. In male patients with RRMS, 23Na-MRI demonstrated a higher sodium signal in the area of the skin compared to age- and biological sex-matched healthy controls with higher sodium, predicting future disease activity in cranial MRI. In both studies, the sodium enrichment was specific to the skin, as we found no alterations of sodium signals in the muscle or other tissues. Our data add to the recently identified importance of the skin as a storage compartment of sodium and may further represent an important organ for future investigations on salt as a proinflammatory agent driving autoimmune neuroinflammation such as that in MS.
CRIS-Team Scopus Importer:2021-07-30
Keywords: Experimental autoimmune encephalomyelitis; Multiple sclerosis; Skin; Sodium magnetic resonance imaging

Small changes in bone structure of female ?7 nicotinic acetylcholine receptor knockout mice - Lips, Katrin S.; Yanko, Oezcan; Kneffel, Mathias; Panzer, Imke; Kauschke, Vivien; Madzharova, Maria; Henss, Anja; Schmitz, Peter; Rohnke, Marcus; Bäuerle, Tobias; Liu, Yifei; Kampschulte, Marian; et al. (BMC Musculoskeletal Disorders, 2015)
Recently, analysis of bone from knockout mice identified muscarinic acetylcholine receptor subtype M3 (mAChR M3) and nicotinic acetylcholine receptor (nAChR) subunit ?2 as positive regulator of bone mass accrual whereas of male mice deficient for ?7-nAChR (?7KO) did not reveal impact in regulation of bone remodeling. Since female sex hormones are involved in fair coordination of osteoblast bone formation and osteoclast bone degradation we assigned the current study to analyze bone strength, composition and microarchitecture of female ?7KO compared to their corresponding wild-type mice (?7WT).Vertebrae and long bones of female 16-week-old ?7KO (n = 10) and ?7WT (n = 8) were extracted and analyzed by means of histological, radiological, biomechanical, cell- and molecular methods as well as time of flight secondary ion mass spectrometry (ToF-SIMS) and transmission electron microscopy (TEM).Bone of female ?7KO revealed a significant increase in bending stiffness (p < 0.05) and cortical thickness (p < 0.05) compared to ?7WT, whereas gene expression of osteoclast marker cathepsin K was declined. ToF-SIMS analysis detected a decrease in trabecular calcium content and an increase in C4H6N(+) (p < 0.05) and C4H8N(+) (p < 0.001) collagen fragments whereas a loss of osteoid was found by means of TEM.Our results on female ?7KO bone identified differences in bone strength and composition. In addition, we could demonstrate that ?7-nAChRs are involved in regulation of bone remodelling. In contrast to mAChR M3 and nAChR subunit ?2 the ?7-nAChR favours reduction of bone strength thereby showing similar effects as ?7?2-nAChR in male mice. nAChR are able to form heteropentameric receptors containing ?- and ?-subunits as well as the subunits ?7 can be arranged as homopentameric cation channel. The different effects of homopentameric and heteropentameric ?7-nAChR on bone need to be analysed in future studies as well as gender effects of cholinergic receptors on bone homeostasis.
EVALuna2:14501

Small direct right ventricular cardiac metastasis of osteosarcoma in a 10-year-old boy affirmed by cardiac MRI - Linder, Verena; Fritscher, Torsten; Hammon, Matthias; Schroth, Michael; Schmidt, Wolfgang; Uder, Michael; Rompel, Oliver (Radiology Case Reports, 2020)
Background: Metastatic osteosarcoma with direct cardiac involvement is an exceptionally rare finding. Reliable detection of cardiac metastases is known to be crucial for patients therapy and prognosis. Case Summary: In a 10-year-old boy affected by osteosarcoma of the left femur, a baseline Fluorine-18-fluorodeoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed to assess the full extent of disease. Whole-body scan detected numerous bone metastases together with a single pulmonary metastasis. Moreover, increased tracer uptake was observed in the intracavitary right cardiac ventricle in the position of a subtle spot of calcification. Because of nondetectability of a cavitary lesion on echocardiography, cardiac magnetic resonance imaging (CMRI) examination was performed to evaluate cardiac 18F-FDG PET/CT finding. CMRI revealed a small nodule in the right ventricle attached to the trabeculae, highly suspicious of a direct cardiac metastasis. After 4 cycles of chemotherapy, complete regression of tracer uptake of the lesion was observed on a follow-up 18F-FDG PET/CT scan. Conclusion: CMRI is able to detect even small, clinically asymptomatic cardiac metastases in young patients affected by osteosarcoma.
CRIS-Team Scopus Importer:2020-04-17
Keywords: CMRI; Direct cardiac metastasis; Osteosarcoma

Smart forecasting of artifacts in contrast-enhanced breast MRI before contrast agent administration - Liebert, Andrzej; Das, Badhan Kumar; Kapsner, Lorenz; Eberle, Jörg; Skwierawska, Dominika; Folle, Lukas; Schreiter, Hannes; Laun, Frederik Bernd; Ohlmeyer, Sabine; Uder, Michael; Wenkel, Evelyn; Bickelhaupt, Sebastian (European Radiology, 2023)
Objectives: To evaluate whether artifacts on contrast-enhanced (CE) breast MRI maximum intensity projections (MIPs) might already be forecast before gadolinium-based contrast agent (GBCA) administration during an ongoing examination by analyzing the unenhanced T1-weighted images acquired before the GBCA injection. Materials and methods: This IRB-approved retrospective analysis consisted of n = 2884 breast CE MRI examinations after intravenous administration of GBCA, acquired with n = 4 different MRI devices at different field strengths (1.5 T/3 T) during clinical routine. CE-derived subtraction MIPs were used to conduct a multi-class multi-reader evaluation of the presence and severity of artifacts with three independent readers. An ensemble classifier (EC) of five DenseNet models was used to predict artifacts for the post-contrast subtraction MIPs, giving as the input source only the pre-contrast T1-weighted sequence. Thus, the acquisition directly preceded the GBCA injection. The area under ROC (AuROC) and diagnostics accuracy scores were used to assess the performance of the neural network in an independent holdout test set (n = 285). Results: After majority voting, potentially significant artifacts were detected in 53.6% (n = 1521) of all breast MRI examinations (age 49.6 ± 12.6 years). In the holdout test set (mean age 49.7 ± 11.8 years), at a specificity level of 89%, the EC could forecast around one-third of artifacts (sensitivity 31%) before GBCA administration, with an AuROC = 0.66. Conclusion: This study demonstrates the capability of a neural network to forecast the occurrence of artifacts on CE subtraction data before the GBCA administration. If confirmed in larger studies, this might enable a workflow-blended approach to prevent breast MRI artifacts by implementing in-scan personalized predictive algorithms. Clinical relevance statement: Some artifacts in contrast-enhanced breast MRI maximum intensity projections might be predictable before gadolinium-based contrast agent injection using a neural network. Key Points: • Potentially significant artifacts can be observed in a relevant proportion of breast MRI subtraction sequences after gadolinium-based contrast agent administration (GBCA). • Forecasting the occurrence of such artifacts in subtraction maximum intensity projections before GBCA administration for individual patients was feasible at 89% specificity, which allowed correctly predicting one in three future artifacts. • Further research is necessary to investigate the clinical value of such smart personalized imaging approaches.
CRIS-Team Scopus Importer:2023-12-22
Keywords: Artifact; Breast; Forecasting; Magnetic resonance imaging; Neural networks (computer)

Snack food as a modulator of human resting-state functional connectivity. - Mendez Torrijos, Andrea; Kreitz, Silke; Ivan, Claudiu-Ionut; Konerth, Laura; Rösch, Julie; Pischetsrieder, Monika; Moll, Gunther; Kratz, Oliver; Dörfler, Arnd; Horndasch, Stefanie; Hess, Andreas (Cns Spectrums, 2018)
OBJECTIVE To elucidate the mechanisms of how snack foods may induce non-homeostatic food intake, we used resting state functional magnetic resonance imaging (fMRI), as resting state networks can individually adapt to experience after short time exposures. In addition, we used graph theoretical analysis together with machine learning techniques (support vector machine) to identifying biomarkers that can categorize between high-caloric (potato chips) vs. low-caloric (zucchini) food stimulation. METHODS Seventeen healthy human subjects with body mass index (BMI) 19 to 27 underwent 2 different fMRI sessions where an initial resting state scan was acquired, followed by visual presentation of different images of potato chips and zucchini. There was then a 5-minute pause to ingest food (day 1=potato chips, day 3=zucchini), followed by a second resting state scan. fMRI data were further analyzed using graph theory analysis and support vector machine techniques. RESULTS Potato chips vs. zucchini stimulation led to significant connectivity changes. The support vector machine was able to accurately categorize the 2 types of food stimuli with 100% accuracy. Visual, auditory, and somatosensory structures, as well as thalamus, insula, and basal ganglia were found to be important for food classification. After potato chips consumption, the BMI was associated with the path length and degree in nucleus accumbens, middle temporal gyrus, and thalamus. CONCLUSION The results suggest that high vs. low caloric food stimulation in healthy individuals can induce significant changes in resting state networks. These changes can be detected using graph theory measures in conjunction with support vector machine. Additionally, we found that the BMI affects the response of the nucleus accumbens when high caloric food is consume
Keywords: Food intake; graph theory; resting state networks; RS-fMRi; snack food; support vector machine

Snapshot CEST++: Advancing rapid whole-brain APTw-CEST MRI at 3 T - Sedykh, Maria; Liebig, Patrick; Herz, Kai; Fabian, Moritz; Mennecke, Angelika; Weinmüller, Simon; Schmidt, Manuel; Dörfler, Arnd; Zaiß, Moritz (NMR in Biomedicine, 2023)
APTw CEST MRI suffers from long preparation times and consequently long acquisition times ( 5 min). Recently, a consensus on the preparation module for clinical APTw CEST at 3 T was found in the community, and we present a fast whole-brain APTw CEST MRI sequence following this consensus preparation of pulsed RF irradiation of 2 s duration at 90% RF duty-cycle and a B1,rms of 2 μT. After optimization of the snapshot CEST approach for APTw imaging regarding flip angle, voxel size and frequency offset sampling, we extend it by undersampled GRE acquisition and compressed sensing reconstruction. This allows 2 mm isotropic whole-brain APTw imaging for clinical research at 3 T below 2 min. With this sequence, a fast snapshot APTw imaging method is now available for larger clinical studies of brain tumors.
CRIS-Team Scopus Importer:2023-08-04
Keywords: 3T CEST; APTw; brain tumor; compressed sensing; snapshot CEST

Sodium Accumulates in the Skin of Psoriasis Patients and in Mice with Psoriasis-Like Skin Disease - Marko, Lajos; Wild, Johannes; Rakova, Natalia; Balogh, Andras; Opitz, Elisa; Linz, Peter; Birukov, Anna; Wilck, Nicola; Dechend, Ralf; Titze, Jens; Kleinewietfeld, Markus; Krause, Andreas; et al. (BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY, 2020)
CRIS-Team WoS Importer:2020-02-07

Sodium and quantitative hydrogen parameter changes in muscle tissue after eccentric exercise and in delayed-onset muscle soreness assessed with magnetic resonance imaging - Höger, Svenja; Gast, Lena; Marty, Benjamin; Hotfiel, Thilo; Bickelhaupt, Sebastian; Uder, Michael; Heiß, Rafael; Nagel, Armin Michael (NMR in Biomedicine, 2022)
The objective of the current study was to assess sodium (Na-23) and quantitative proton (H-1) parameter changes in muscle tissue with magnetic resonance imaging (MRI) after eccentric exercise and in delayed-onset muscle soreness (DOMS). Fourteen participants (mean age: 25 +/- 4 years) underwent Na-23/H-1 MRI of the calf muscle on a 3-T MRI system before exercise (t0), directly after eccentric exercise (t1), and 48 h postintervention (t2). In addition to tissue sodium concentration (TSC), intracellular-weighted sodium (ICwS) signal was acquired using a three-dimensional density-adapted radial projection readout with an additional inversion recovery preparation module. Phantoms containing saline solution served as references to quantify sodium concentrations. The H-1 MRI protocol consisted of a T-1-weighted turbo spin echo sequence, a T-2-weighted turbo inversion recovery, as well as water T-2 mapping and water T-1 mapping. Additionally, blood serum creatine kinase (CK) levels were assessed at baseline and 48 h after exercise. The TSC and ICwS of exercised muscles increased significantly from t0 to t1 and decreased significantly from t1 to t2. In the soleus muscle (SM), ICwS decreased below baseline values at t2. In the tibialis anterior muscle (TA), TSC and ICwS remained at baseline levels at each measurement point. However, high-CK participants (i.e., participants with a more than 10-fold CK increase, n = 3) displayed different behavior, with 2- to 4-fold increases in TSC values in the medial gastrocnemius muscle (MGM) at t2. H-1 water T-1 relaxation times increased significantly after 48 h in the MGM and SM. H-1 water T-2 relaxation times and muscle volume increased in the MGM at t2. Sodium MRI parameters and water relaxation times peaked at different points. Whereas water relaxation times were highest at t2, sodium MRI parameters had already returned to baseline values (or even below baseline values, for low-CK participants) by this point. The observed changes in ion concentrations and water relaxation time parameters could enable a better understanding of the physiological processes during DOMS and muscle regeneration. In the future, this might help to optimize training and to reduce associated sports injuries.
CRIS-Team WoS Importer:2022-11-25

Sodium MRI of human articular cartilage of the wrist: a feasibility study on a clinical 3T MRI scanner - Müller-Lutz, Anja; Kamp, Benedikt; Nagel, Armin Michael; Ljimani, Alexandra; Abrar, Daniel; Schleich, Christoph; Wollschläger, Lena; Nebelung, Sven; Wittsack, Hans Jörg (Magnetic Resonance Materials in Physics Biology and Medicine, 2020)
Objective: To measure sodium relaxation times and concentrations in human wrists on a clinical magnetic resonance imaging (MRI) scanner with a density-adapted radial sequence. Materials and methods: Sodium MRI of human wrists was conducted on a 3T MR system using a dual-tuned 1H/23Na surface coil. We performed two studies with 10 volunteers each investigating either sodium T1 (study 1) or sodium T2* (study 2) relaxation times in the radiocarpal joint (RCJ) and midcarpal joint (MCJ). Sodium concentrations of both regions were determined. Results: No differences for transversal of longitudinal relaxation times were found between RCJ and MCJ (T2,s*(RCJ) = (0.9 ± 0.4) ms; T2,s*(MCJ) = (0.9 ± 0.3) ms; T2,l*(RCJ) = (14.9 ± 0.9) ms; T2,l*(MCJ) = (13.9 ± 1.1) ms; T1(RCJ) = (19.0 ± 2.4) ms; T1(MCJ) = (18.5 ± 2.1) ms). Sodium concentrations were (157.7 ± 28.4) mmol/l for study 1 and (159.8 ± 29.1) mmol/l for study 2 in the RCJ, and (172.7 ± 35.6) mmol/l for study 1 and (163.4 ± 26.3) mmol/l for study 2 in the MCJ. Conclusion: We successfully determined sodium relaxation times and concentrations of the human wrist on a 3T MRI scanner.
CRIS-Team Scopus Importer:2020-06-16
Keywords: 23Na MRI; Cartilage; Magnetic resonance imaging; Sodium; Sodium relaxation times; Wrist

Sodium (Na-23) In Vivo Magnetic Resonance Imaging of the Human Eye at 7.0 Tesla: a New Tool to Investigate Ocular Disorders - Wenz, Daniel; Stachs, Oliver; Kuehne, Andre; Huelnhagen, Till; Nagel, Armin Michael; Waiczies, Helmar; Seeliger, Erdmann; Flemming, Bert; Niendorf, Thoralf (2018)
EVALuna2:36244

Sodium relaxometry using 23 Na MR fingerprinting: A proof of concept - Kratzer, Fabian J.; Flassbeck, Sebastian; Nagel, Armin Michael; Behl, Nicolas G.R.; Knowles, Benjamin R.; Bachert, Peter; Ladd, Mark E.; Schmitter, Sebastian (Magnetic Resonance in Medicine, 2020)
PURPOSE: To evaluate the feasibility of 23 Na MR fingerprinting (MRF) for simultaneous quantification of T1 , formula presented , formula presented in addition to ΔB0 . METHODS: A framework for sodium relaxometry using MRF at 7T was developed, allowing simultaneous measurement of relaxation times and inhomogeneities in the static field. The technique distinguishes between bi- and monoexponential transverse relaxation and was validated in simulations with respect to the ground truth. In phantom measurements, a resolution of 2 × 2 × 12 mm3 was achieved within 1 h acquisition time, and the resulting parameter maps were compared to results from reference methods. Relaxation times in five healthy volunteers were measured with a resolution of 4 × 4 × 12 mm3 . RESULTS: Phantom experiments revealed an agreement between the relaxation times obtained via 23 Na-MRF and the reference methods. In white matter, a longitudinal relaxation constant of T1 = 38.9 ± 4.8 ms was found, while values of formula presented = 29.2 ± 4.9 ms and formula presented = 4.7 ± 1.2 ms were found for the long and short component of the transverse relaxation. In cerebrospinal fluid, T1 was 67.7 ± 6.3 ms and formula presented = 41.5 ± 3.4 ms. CONCLUSION: This work demonstrates the feasibility of 23 Na-MRF for relaxometry in sodium MRI in both phantom and in vivo studies. Simultaneous quantification of T1 , formula presented , formula presented and ΔB0 was possible within a 1 h measurement time.
CRIS-Team Scopus Importer:2020-06-30
Keywords: magnetic resonance fingerprinting; MRI; relaxometry; sodium; X-Nuclei

Soluble CD83 Triggers Resolution of Arthritis and Sustained Inflammation Control in IDO Dependent Manner - Royzman, Dmytro; Andrev, Darja; Stich, Lena; Rauh, Manfred; Bäuerle, Tobias; Ellmann, Stephan; Boon, Louis; Kindermann, Markus; Peckert, Katrin; Bozec, Aline; Schett, Georg; Steinkasserer, Alexander; et al. (Frontiers in Immunology, 2019)
Interference with autoimmune-mediated cytokine production is a key yet poorly developed approach to treat autoimmune and inflammatory diseases such as rheumatoid arthritis. Herein, we show that soluble CD83 (sCD83) enhances the resolution of autoimmune antigen-induced arthritis (AIA) by strongly reducing the expression levels of cytokines such as IL-17A, IFN gamma, IL-6, and TNF alpha within the joints. Noteworthy, also the expression of RANKL, osteoclast differentiation, and joint destruction was significantly inhibited by sCD83. In addition, osteoclasts which were cultured in the presence of synovial T cells, derived from sCD83 treated AIA mice, showed a strongly reduced number of multinuclear large osteoclasts compared to mock controls. Enhanced resolution of arthritis by sCD83 was mechanistically based on IDO, since inhibition of IDO by 1-methyltryptophan completely abrogated sCD83 effects on AIA. Blocking experiments, using anti-TGF-beta antibodies further revealed that also TGF-beta is mechanistically involved in the sCD83 induced reduction of bone destruction and cartilage damage as well as enhanced resolution of inflammation. Resolution of arthritis was associated with increased numbers of regulatory T cells, which are induced in a sCD83-IDO-TGF-beta dependent manner. Taken together, sCD83 represents an interesting approach for downregulating cytokine production, inducing regulatory T cells and inducing resolution of autoimmune arthritis.
CRIS-Team WoS Importer:2019-04-12

Spatial Distribution of Muscular Effects of Acute Whole-Body Electromyostimulation at the Mid-Thigh and Lower Leg-A Pilot Study Applying Magnetic Resonance Imaging - Götz, Marina; Heiß, Rafael; von Stengel, Simon; Roemer, Frank; Berger, Joshua; Nagel, Armin Michael; Uder, Michael; Kemmler, Wolfgang (Sensors, 2022)
Whole-body electromyostimulation (WB-EMS) is an innovative training method that stimulates large areas simultaneously. In order to determine the spatial distribution of WB-EMS with respect to volume involvement and stimulation depth, we determined the extent of intramuscular edema using magnetic resonance imaging (MRI) as a marker of structural effects. Intense WB-EMS first application (20 min, bipolar, 85 Hz, 350 mu s) was conducted with eight physically less trained students without previous WB-EMS experience. Transversal T2-weighted MRI was performed at baseline and 72 h post WB-EMS to identify edema at the mid-thigh and lower leg. The depth of the edema ranged from superficial to maximum depth with superficial and deeper muscle groups of the mid-thigh or lower leg area approximately affected in a similar fashion. However, the grade of edema differed between the muscle groups, which suggests that the intensity of EMS-induced muscular contraction was not identical for all muscles. WB-EMS of the muscles via surface cuff electrodes has an effect on deeper parts of the stimulated anatomy. Reviewing the spatial and volume distribution, we observed a heterogeneous pattern of edema. We attribute this finding predominately to different stimulus thresholds of the muscles and differences in the stress resistance of the muscles.
CRIS-Team WoS Importer:2023-01-27

Specific cerebral multiple sclerosis lesions are associated with sympathetic cardiovascular activation - Winder, K.; Linker, R. A.; Seifert, F.; Wang, R.; Lee, D-H.; Engelhorn, Tobias; Dörfler, Arnd; Fröhlich, Katharina; Hilz, M. J. (EUROPEAN JOURNAL OF NEUROLOGY, 2019)
CRIS-Team WoS Importer:2019-07-30

Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage - Gerner, Stefan; Kuramatsu, Joji; Möller, Sebastian; Huber, Angelika; Lücking, Hannes; Kloska, Stephan; Madzar, Dominik; Sembill, Jochen; Schwab, Stefan; Huttner, Hagen (Stroke, 2017)
Several studies have reported a better functional outcome in lobar intracerebral hemorrhage (ICH) compared with deep location. However, among lobar ICH, a correlation of hemorrhage site-involving the specific lobes-with functional outcome has not been established.Conservatively treated patients with supratentorial ICH, admitted to our hospital over a 5-year period (2008-2012), were retrospectively analyzed. Lobar patients were classified as isolated or overlapping ICH according to affected lobes. Demographic, clinical, and radiological characteristics were recorded and compared among lobar ICH patients using above subclassification. Functional outcome-dichotomized into favorable (modified Rankin Scale, 0-3) and unfavorable (modified Rankin Scale, 4-6)-was assessed after 3 and 12 months. Multivariate regression analysis was performed to identify predictors for favorable outcome.Of overall 553 patients, 260 had lobar ICH. In isolated lobar ICH, median hematoma-volume decreased from rostral (frontal, 22.4 mL [7.3-55.5 mL]) to caudal (occipital, 7.1 mL [5.2-16.4 mL]; P=0.045), whereas the proportion of patients with favorable outcome increased (frontal: 23/63 [36.5%] versus occipital: 10/12 [83.3%]; P=0.003). Patients with overlapping lobar ICH had larger ICH volumes than isolated lobar ICH (overlapping, 48.9 mL [22.6-78.5 mL] versus 15.3 mL [5.0-44.6 mL]; P<0.001) and poorer clinical status on admission (Glasgow Coma Scale and National Institutes of Health Stroke Scale). Correlations with anatomic aspects provided evidence of a rostrocaudal gradient with increasing gray/white-matter ratio and decreasing hematoma-volume and rate of hematoma enlargement from frontal to occipital ICH location. Multivariate analysis revealed affection of occipital lobe (odds ratio, 3.75 [1.38-10.22]) and affection of frontal lobe (odds ratio, 0.52 [0.28-0.94]) to be independent predictors for favorable outcome and unfavorable outcome, respectively.Among patients with lobar ICH radiological and outcome characteristics differed according to location. Especially affection of the frontal lobe was frequent and associated with unfavorable outcome after 3 months.
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SPECT/CT With the PSMA Ligand 99mTc-MIP-1404 for Whole-Body Primary Staging of Patients With Prostate Cancer - Schmidkonz, Christian; Cordes, Michael; Beck, Michael; Goetz, Theresa Ida; Schmidt, Daniela; Prante, Olaf; Bäuerle, Tobias; Uder, Michael; Wullich, Bernd; Goebell, Peter; Kuwert, Torsten; Ritt, Philipp (Clinical Nuclear Medicine, 2018)
BACKGROUND: Tc-MIP-1404 (Progenics Pharmaceuticals, Inc, New York, NY) is a novel ligand binding to prostate-specific membrane antigen suitable for SPECT. There are, as yet, no data concerning its use in whole-body primary staging and its interobserver variability in patients with prostate cancer (PC) prior to therapy. METHODS: A search of our clinical database from April 2013 to May 2017 yielded 93 patients with histologically confirmed cancer in whom Tc-MIP-1404 SPECT/CT had been performed for primary whole-body staging before therapy. Whole-body planar and SPECT/CT images of the lower abdomen and thorax had been obtained 3 to 4 hours postinjection of 706 ± 72 MBq Tc-MIP-1404. Images were visually analyzed for extent and location of abnormal uptake by 2 experienced nuclear physicians. Interobserver agreement for detection of primary tumor and metastatic lesions was assessed. In addition, SUVs of prostate-specific membrane antigen-positive regions of the prostate were determined in all patients, and from these, a variable reflecting total tumor load in the prostate gland was calculated (TUprostate). Follow-up reports of subsequent therapeutic interventions were available in 52 (56%) of all patients with a median follow-up of 18 months. RESULTS: In 90 (97%) of 93 patients, prostate uptake above background was detected as correlate of the histologically diagnosed PC. Forty-eight lymph node and 29 bone metastases were detected in 16 and 9 patients, respectively. In addition, 3 patients had disseminated bone metastases. No distant organ metastases were found. Interobserver agreement was high for the overall scan result (97%), as well as for the detection of the primary tumor (97%), of lymph node metastases (97%), and of bone metastases (99%). Recurrence of PC occurred in 5 patients in whom follow-up was available (10%). TUprostate was significantly higher in patients with Gleason scores of 8 or greater compared with patients with Gleason scores of 7 or less and at prostate-specific antigen (PSA) serum levels of 10 ng/mL or greater compared with PSA serum levels of 10 ng/mL or less. TUprostate of greater than 26 in the primary tumor predicted the occurrence of lymph node or bone metastases with a sensitivity of 82% and specificity of 76%. CONCLUSIONS: MIP-1404 SPECT/CT has a high accuracy and low interobserver variability in the diagnosis of PC and allows detection of lymph node and bone metastases in a significant proportion of as yet untreated PC patients. TUprostate is correlated with Gleason score and PSA serum concentration and allows prediction of the occurrence of lymph node and bone metastases with moderate accuracy at primary staging.
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Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults after Intravenous Application - A Retrospective Trial - Knieling, Ferdinand; Strobel, Deike; Rompel, O.; Zapke, M.; Menendez-Castro, C.; Woelfel, M.; Schulz, J.; Rascher, Wolfgang; Juengert, J. (Ultraschall in der Medizin, 2016)
Purpose: To investigate the spectrum, applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound imaging (CEUS) in a pediatric population. Materials and Methods: From 08/2005 to 11/2015, n = 40 pediatric patients and young adults from 0 - 26 years (Ø 11.4 ± 7.5) and 3.0 - 85.3 kg (Ø 40.8 ± 25.6) with n = 55 investigations received n = 79 IV applications of ultrasound contrast agent (UCA). UCA dose and side effects were documented. Scanned organs were the liver (n = 42), spleen (n = 9), kidney (n = 3), and testis (n = 1). Histology, surgery or reference imaging was compared to CEUS and clinical follow-up. Results: The UCA dose < 20 kg was 0.4 ± 0.3 ml, (0.05 ± 0.02 ml/kg) and > 20 kg was 1.0 ± 0.4 ml (p< 0.0001) (0.02 ± 0.01 ml/kg, p< 0.0001). Adverse effects occurred in 2/79 applications (2.5 %). Agreement CEUS/gold standard resulted in 32/34 investigations. For liver diagnostics (gold standard: MRI, CT, histology, serology), n = 11 malignant and n = 15 benign focal liver lesions were included. The specificity was 100 % (95 % CI: 0.77 - 1.00), the sensitivity was 82 % (95 % CI: 0.48 - 0.98), the positive predictive value was 100 % (95 % CI: 0.69 - 1.00) and the negative predictive value was 88 % (95 % CI: 0.62 - 0.98, p< 0.0001). In n = 2 reference imaging misdiagnosed and CEUS was in accordance with clinical follow-up. All splenic/renal lesions were diagnosed correctly. In n = 1 an insufficient testicular perfusion was ruled out. The observation time was 30.4 ± 30.5 months. Conclusion: CEUS is a well-tolerated and diagnostically equivalent modality in pediatric care, providing fundamental advantages compared to currently approved imaging modalities for these age groups.
EVALuna2:14718

Spiral breast computed tomography with a photon-counting detector (SBCT): The future of breast imaging? - Wetzl, Matthias; Dietzel, Matthias; Ohlmeyer, Sabine; Uder, Michael; Wenkel, Evelyn (European Journal of Radiology, 2022)
Dedicated breast computed tomography (BCT) is an emerging breast imaging modality. The latest development has been the introduction of a spiral breast computed tomography scanner equipped with a photon-counting detector (SBCT). SBCT promises multiple advantages: Unlike conventional mammography, contrast enhanced spectral mammography (CESM: both 2D), and digital breast tomosynthesis (DBT: pseudo 3D), SBCT enables 3D breast imaging without tissue overlap. SBCT achieves high isotropic spatial resolution of breast tissue enabling the assessment of both soft tissue and microcalcifications. Similar to CESM and MRI, SBCT supports contrast-enhanced imaging, enabling the assessment of breast neovascularization. Unlike mammography and its derived methods (CESM, DBT), SBCT does not require compression of the breast. Accordingly, women consistently report significantly increased patient comfort compared to mammography in a previous investigation. Radiation safety is crucial in breast imaging. Studies showed different results in terms of dose, with some staying within the limits of two-view FFDM defined by the ACR and others exceeding the limit by up to 21%. Therefore, a higher radiation dose compared to state-of-the-art mammography and DBT systems has to be acknowledged. SBCT is currently under scientific investigation in multiple trials. Three major indications are currently explored: Whereas our colleagues in Zurich/Switzerland investigate the role of SBCT for opportunistic screening, in our department SBCT is mainly indicated for the work-up of equivocal lesions, and for preoperative staging. In this narrative review, we summarize the concepts of SBCT and potential implications for patient care. We report on our initial clinical experience with the technology and outline future developments of SBCT.
CRIS-Team Scopus Importer:2022-12-09
Keywords: Breast imaging; Dedicated breast computed tomography

SPONTANEOUS HEALING OF THE RUPTURED ANTERIOR CRUCIATE LIGAMENT: OBSERVATIONS FROM THE KANON TRIAL - Filbay, S.; Roemer, Frank; Lohmander, S.; Turkiewicz, A.; Roos, E. M.; Frobell, R.; Englund, M. (OSTEOARTHRITIS AND CARTILAGE, 2022)
CRIS-Team WoS Importer:2022-04-22

Sports Injuries at the Rio de Janeiro 2016 Summer Olympics: Use of Diagnostic Imaging Services - Guermazi, Ali; Hayashi, Daichi; Jarraya, Mohamed; Crema, Michel D.; Bahr, Roald; Roemer, Frank; Grangeiro, Joao; Budgett, Richard G.; Soligard, Torbjorn; Domingues, Romulo; Skaf, Abdalla; Engebretsen, Lars (Radiology, 2018)
Purpose To describe the occurrence of imaging-depicted sports-related stress injuries, fractures, and muscle and tendon disorders during the 2016 Summer Olympic Games in Rio de Janeiro, Brazil. Materials and Methods Data on radiologic examinations were collected and retrospectively analyzed centrally by two board-certified musculoskeletal radiologists (with a third musculoskeletal radiologist acting as an adjudicator in case of discrepancies). Descriptive data on all imaging examinations by using radiography, ultrasonography (US), and magnetic resonance (MR) imaging were collected and analyzed according to imaging modality, country of origin of the athletes, type of sport, and type and location of injury. Results There were 1101 injuries that occurred in 11 274 (9.8%) athletes. A total of 1015 radiologic examinations were performed, including 304 (30.0%) radiographic, 104 (10.2%) US, and 607 (59.8%) MR examinations. Excluding 10 athletes categorized as refugees, athletes from Africa had the highest utilization rate (14.8%, 148 of 1001). Athletes from Europe underwent the most examinations with 103 radiographic, 39 US, and 254 MR examinations. Gymnastics (artistic) had the highest percentage of athletes who underwent imaging (15.5%, 30 of 194). Athletics (track and field) had the most examinations (293, including 53 radiographic, 50 US, and 190 MR examinations). Conclusion The overall occurrence of imaging used to help diagnose sports-related injuries at the Rio de Janeiro 2016 Summer Olympics was 6.4% of athletes. In these cases, MR imaging comprised 60% of imaging utilization. © RSNA, 2018 Online supplemental material is available for this article.
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Sports injuries at the Rio de Janeiro 2016 Summer Paralympic Games: use of diagnostic imaging services - Jarraya, Mohamed; Blauwet, Cheri A.; Crema, Michel D.; Heiß, Rafael; Roemer, Frank; Hayashi, Daichi; Derman, Wayne E.; Guermazi, Ali (European Radiology, 2021)
Objective To describe the occurrence of imaging-depicted sports-related injuries (bone, muscle, tendon, and ligament injuries) during the Rio 2016 Summer Paralympic Games. Methods Descriptive data on all imaging examinations by using radiography, ultrasonography (US), and MRI were collected and retrospectively analyzed centrally by five musculoskeletal radiologists according to imaging modality, country of origin of the athletes, type of sport, type of disability, and type and location of injury. Results We report 109 injuries in 4378 athletes. A total of 382 radiologic examinations were performed in 261 athletes, including 118 (31%) radiographic, 22 (6%) US, and 242 (63%) MRI examinations. Para athletes from Africa had the highest utilization rate (20.1%, 67 out of 333). Athletes from Europe underwent the most examinations with 29 radiographic, 12 US, and 66 MRI examinations. The highest utilization rate of imaging modalities by sport was among Judo para athletes (16.7%, 22 out of 132). Most injuries were reported in athletics discipline (37.6%, 41 out of 109). Most injuries were also reported among para athletes with visual impairment (40 injuries, 36.7% of all injuries). Bone stress injuries were most common among para athletes with visual impairment (6 out of 7). Para athletes with visual impairment were also more prone to bone stress injuries than traumatic fractures, unlike para athletes with neurologic and musculoskeletal impairments. Conclusions Imaging was used in 6.0% of para athletes. MRI comprised 63% of imaging utilization. Identification of patterns of injuries may help building future prevention programs in elite para athletes.
CRIS-Team WoS Importer:2021-03-19

Standardized acquisition and post-processing of dynamic susceptibility contrast perfusion in patients with brain tumors, cerebrovascular disease and dementia: comparability of post-processing software - Schmidt, Manuel; Knott, Michael; Engelhorn, Tobias; Larsson, Elna Marie; Nguyen, Than; Essig, Marco; Dörfler, Arnd; Hölter, Philip (British Journal of Radiology, 2020)
OBJECTIVE: MR-perfusion post-processing still lacks standardization. This study evaluates the results of perfusion analysis with two established software solutions in a large series of patients with different diseases when a highly standardized processing workflow is ensured. METHODS: Multicenter data of 260 patients (80 with brain tumors, 124 with cerebrovascular disease and 56 with dementia examined with the same MR protocol) were analyzed. Raw data sets were processed with two software suites: Olea sphere and NordicICE. Group differences were analyzed with paired t-tests and one-way ANOVA. RESULTS: Perfusion metrics were significantly different for all examined diseases in the unaffected brain for both software suites [ratio cortex/white matter left hemisphere: mean transit time (MTT) 0.991 vs 0.847, p < 0.05; relative cerebral bloodflow (rBF) 3.23 vs 4.418, p < 0.001; relative cerebral bloodvolume (rBVc) 2.813 vs 3.884, p < 0.001; right hemisphere: MTT 1.079 vs 0.854, p < 0.05; rBF 3.262 vs 4.378, p < 0.001; rBVc 2.762 vs 3.935, p < 0.001)]. Perfusion results were also significantly different in patients with stroke (ratio cortex/white matter affected hemisphere: MTT 1.058 vs 0.784; p < 0.001), dementia (ratio cortex/white matter left hemisphere: rBVc 1.152 vs 1.795, p < 0.001; right hemisphere: rBVc 1.396 vs 1.662, p < 0.05) and brain tumors (ratio cortex/whole tumor rBVc: 0.778 vs 0.919, p < 0.001 and ratio cortex/tumor hotspot rBVc: 0.529 vs 0.512, p < 0.05). CONCLUSION: Despite a highly standardized workflow, parametric perfusion maps are depended on the chosen software. Radiologists should consider software related variances when using dynamic susceptibility contrast perfusion for clinical imaging and research. ADVANCES IN KNOWLEDGE: This multicenter study compared perfusion parameters calculated by two commercial dynamic susceptibility contrast perfusion post-processing software solutions in different central nervous system disorders with a large sample size and a highly standardized processing workflow. Despite, parametric perfusion maps are depended on the chosen software which impacts clinical imaging and research.
CRIS-Team Scopus Importer:2019-12-24

Standardized multi-vendor compositional MRI of knee cartilage: a key step towards clinical translation? - MacKay, J. W.; Roemer, Frank; Kogan, F. (Osteoarthritis and Cartilage, 2020)
CRIS-Team Scopus Importer:2020-12-11
Keywords: Cartilage; Imaging biomarker; Magnetic resonance imaging; Osteoarthritis

Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology - Hunold, Peter; Bucher, Andreas Michael; Sandstede, Joern; Janka, Rolf Matthias; Fritz, Lars Benjamin; Regier, Marc; Loose, Reinhard; Barkhausen, Joerg; Mentzel, Hans-Joachim; Zimmer, Claus; Antoch, Gerald; Schoenberg, Stefan O.; et al. (Röfo: Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021)
Background Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results. Therefore, MRI requires higher physician qualification and expertise than any other diagnostic imaging technique in medicine. This holds true for indication, performance of the examination itself, and in particular for image evaluation and writing of the report. In Germany, the radiologist is the only specialist who is systematically educated in all aspects of MRI during medical specialty training and who must document a specified, high number of examinations during this training. However, also non- radiologist physicians are increasingly endeavoring to conduct and bill MRI examinations on their own.
CRIS-Team WoS Importer:2021-05-21

State of the Art: Imaging of Osteoarthritis-Revisited 2020 - Roemer, Frank; Demehri, Shadpour; Omoumi, Patrick; Link, Thomas M.; Kijowski, Richard; Saarakkala, Simo; Crema, Michel D.; Guermazi, Ali (Radiology, 2020)
Osteoarthritis (OA) is a highly prevalent chronic condition with marked implications for affected individuals and public health care. There are available treatments to manage pain and symptoms but no effective treatment for OA. In the past 10 years, joint imaging, particularly MRI, has evolved rapidly due to technical advances and their application to clinical research, which has led to abundant evidence regarding the natural history of the disease. Radiography remains the primary imaging modality in clinical practice for the diagnosis and follow-up of OA. The many developments in MRI techniques capable of assessing cartilage morphologic features and the methods for evaluating its biochemical composition will be discussed. Advances in quantitative morphologic-cartilage assessment and semiquantitative whole-organ assessment will be reviewed, as will other modalities such as US, CT and CT arthrography, and nuclear medicine techniques that play a complementary role. Various therapeutic approaches and ongoing developments, including the impact of artificial intelligence on the field of OA imaging, will also be discussed. (C) RSNA, 2020
CRIS-Team WoS Importer:2020-07-10

State of the Art: MR Imaging after Knee Cartilage Repair Surgery - Guermazi, Ali; Roemer, Frank; Alizai, Hamza; Winalski, Carl S.; Welsch, Goetz; Brittberg, Mats; Trattnig, Siegfried (Radiology, 2015)
Cartilage injuries are common, especially in athletes. Because these injuries frequently affect young patients, and they have the potential to progress to osteoarthritis, treatment to alleviate symptoms and delay joint degeneration is warranted. A number of surgical techniques are available to treat focal chondral defects, including marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation. Although arthroscopy is considered the standard of reference for the evaluation of cartilage before and after repair, it is invasive with associated morbidity and cannot adequately depict the deep cartilage layer and underlying bone. Magnetic resonance (MR) imaging provides unparalleled noninvasive assessment of the repair site and all other joint tissues. MR observation of cartilage repair tissue is a well-established semiquantitative scoring system for repair tissue that has primarily been used in clinical research studies. The cartilage repair osteoarthritis knee score (CROAKS) optimizes comprehensive morphologic assessment of the knee joint after cartilage repair. Furthermore, quantitative, compositional MR imaging measurements (eg, T2, T2*, T1?), delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC), and sodium imaging are available for biochemical assessment. These quantitative MR imaging techniques help assess collagen content and orientation, water content, and glycosaminoglycan and/or proteoglycan content both in the repair tissue as it matures and in the "native" cartilage. In this review, the authors discuss the principles of state-of-the-art morphologic and compositional MR imaging techniques for imaging of cartilage repair and their application to longitudinal studies.
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Statin and nodal knee osteoarthritis: a longitudinal propensity score-matched study on the knee osteoarthritis from the osteoarthritis initiative (OAI) cohort - Haj-Mirzaian, A.; Mohajer, B.; Guermazi, A.; Roemer, Frank; Lima, J.; Blaha, M. J.; Bingham, C. O.; Demehri, S. (OSTEOARTHRITIS AND CARTILAGE, 2019)
CRIS-Team WoS Importer:2019-05-21

Statin Use and Knee Osteoarthritis Outcome Measures according to the Presence of Heberden Nodes: Results from the Osteoarthritis Initiative - Roemer, Frank; Haj-Mirzaian, Arya; Mohajer, Bahram; Guermazi, Ali; Conaghan, Philip G.; Lima, Joao A.C.; Blaha, Michael J.; Bingham, Clifton O.; Roemer, Frank W.; Cao, Xu; Demehri, Shadpour (Radiology, 2019)
Background The exact contribution of statins to knee osteoarthritis (OA) radiographic outcomes and the characteristics of patients with OA as potential responders to statins remain unclear. Purpose To evaluate the effect of statin use on the incidence of radiographic knee OA (development of Kellgren-Lawrence grade ≥2) and progression of joint space narrowing (JSN) according to the nodal OA status defined according to the presence of Heberden nodes (HNs). Materials and Methods Institutional review boards approved this HIPAA-compliant protocol, and all participants gave informed consent. The Osteoarthritis Initiative (OAI) cohort, which began in 2004 and is ongoing (https://clinicaltrials.gov identifier, NCT00080171), was used to conduct a longitudinal 1:1 propensity score-matched retrospective analysis of prospectively collected data. Participants were classified as having HN-positive or HN-negative findings according to the presence of HNs at baseline physical examination. In each cohort, per-protocol and new-user design were used to match statin initiators (participants who reported ≤1 year of statin use before enrollment) and nonusers (participants who reported no statin use before enrollment) for variables that potentially contributed to confounding by indication bias. Participants were followed up annually over 8 years. Any associations between statin use and longitudinal knee OA radiographic incidence, JSN progression, or nonacceptable symptomatic state incidence was assessed by using hazard ratios (HRs) of Cox regression. Results In the longitudinal analysis, there were 832 knees of 602 participants (pair-matched knees of statin initiators and nonusers) in the HN-positive cohort (mean age, 64.7 years ± 8.0 [standard deviation]; 377 patients were female [62.6%]) and 386 knees of 285 participants in the HN-negative cohort (mean age, 58.9 years ± 8.2; 144 patients were female [50.5%]). In the HN-positive cohort, statin users had 46% lower risk of JSN progression in comparison with matched nonusers (HR, 0.54; 95% confidence interval [CI]: 0.36, 0.93; P = .02). In contrast, in the HN-negative cohort, statin use had no association with radiographic JSN progression (HR, 1.37; [95% CI: 0.74, 2.53]; P = .32). Conclusion Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. © RSNA, 2019 Online supplemental material is available for this article.
CRIS-Team Scopus Importer:2019-10-25

Statin use and MRI subchondral bone marrow lesion worsening in generalized osteoarthritis: longitudinal analysis from Osteoarthritis Initiative data - Mohajer, Bahram; Guermazi, Ali; Conaghan, Philip G.; Berenbaum, Francis; Roemer, Frank; Haj-Mirzaian, Arya; Bingham, Clifton O.; Moradi, Kamyar; Cao, Xu; Wan, Mei; Demehri, Shadpour (European Radiology, 2022)
Objectives: To determine the association between statin therapy and knee MRI-detected subchondral bone marrow lesion (BML) longitudinal worsening in patients with Heberden’s nodes (HNs) as the hallmark of generalized osteoarthritis (OA) phenotype. Methods: All participants gave informed consent, and IRB approved HIPAA-compliant protocol. We assessed the worsening in BML volume and number of affected subregions in the Osteoarthritis Initiative (OAI) participants with HNs at baseline clinical examination (HN+), using the semi-quantitative MRI Osteoarthritis Knee Scores at baseline and 24 months. Participants were classified according to baseline BML involvement as “no/minimal” (≤ 2/14 knee subregions affected and maximum BML score ≤ 1) or “moderate/severe.” Statin users and non-users were selected using 1:1 propensity-score (PS) matching for OA and cardiovascular disease (CVD)–related potential confounding variables. We assessed the association between statin use and increasing BML score and affected subregions using adjusted mixed-effect regression models. Results: The PS-matched HN+ participants (63% female, aged 63.5 ± 8.5-year-old) with no/minimal and moderate/severe BML cohorts consisted of 332 (166:166, statin users: non-users) and 380 (190:190) knees, respectively. In the HN+ participants with no/minimal BML, statin use was associated with lower odds of both BML score worsening (odds ratio, 95% confidence interval: 0.62, 0.39–0.98) and increased number of affected subregions (0.54, 0.33–0.88). There was no such association in HN– participants or those HN+ participants with baseline moderate/severe BML. Conclusion: In patients with CVD indications for statin therapy and generalized OA phenotype (HN+), statin use may be protective against the OA-related subchondral bone damage only in the subgroup of participants with no/minimal baseline BML. Key Points: • Statin use may reduce the risk of subchondral bone damage in specific osteoarthritis patients with a generalized phenotype, minimal subchondral bone damage, and cardiovascular statin indications.
CRIS-Team Scopus Importer:2022-01-28
Keywords: Bone marrow; Hydroxymethylglutaryl-CoA reductase inhibitors; Knee; Magnetic resonance imaging; Osteoarthritis

Status epilepticus in patients with glioblastoma: Clinical characteristics, risk factors, and epileptological outcome - Stritzelberger, Jenny; Gesmann, Anna; Fuhrmann, Imke; Balk, Stefanie; Reindl, Caroline; Madzar, Dominik; Uhl, Martin; Welte, Tamara; Brandner, Sebastian; Eisenhut, Felix; Dörfler, Arnd; Coras, Roland; et al. (Seizure-European Journal of Epilepsy, 2023)
Purpose: Epilepsy is a common comorbidity in patients with glioblastoma, however, clinical data on status epilepticus (SE) in these patients is sparse. We aimed to investigate the risk factors associated with the occurrence and adverse outcomes of SE in glioblastoma patients. Methods: We retrospectively analysed electronic medical records of patients with de-novo glioblastoma treated at our institution between 01/2006 and 01/2020 and collected data on patient, tumour, and SE characteristics. Results: In the final cohort, 292/520 (56.2 %) patients developed seizures, with 48 (9.4 % of the entire cohort and 16.4 % of patients with epilepsy, PWE) experiencing SE at some point during the course of their disease. SE was the first symptom of the tumour in 6 cases (1.2 %) and the first manifestation of epilepsy in 18 PWE (6.2 %). Most SE episodes occurred postoperatively (n = 37, 77.1 %). SE occurrence in PWE was associated with postoperative seizures and drug-resistant epilepsy. Adverse outcome (in-house mortality or admission to palliative care, 10/48 patients, 20.8 %), was independently associated with higher status epilepticus severity score (STESS) and Charlson Comorbidity Index (CCI), but not tumour progression. 32/48 SE patients (66.7 %) were successfully treated with first- and second-line agents, while escalation to third-line agents was successful in 6 (12.5 %) cases. Conclusion: Our data suggests a link between the occurrence of SE, postoperative seizures, and drug-resistant epilepsy. Despite the dismal oncological prognosis, SE was successfully treated in 79.2 % of the cases. Higher STESS and CCI were associated with adverse SE outcomes.
CRIS-Team Scopus Importer:2023-09-29
Keywords: Glioblastoma; Status epilepticus; Status epilepticus severity score (STESS)

Stent-Assisted Coiling Using Leo+ Baby Stent: Immediate and Mid-Term Results - Lücking, Hannes; Struffert, Tobias; Gölitz, Philipp; Engelhorn, Tobias; Brandner, Sebastian; Kuramatsu, Joji; Lang, Stefan; Schmidt, Manuel; Dörfler, Arnd (Clinical Neuroradiology, 2020)
Background: Stent-assisted coiling is well-established for treatment of cerebral aneurysms. The technique enables treatment of wide-neck, bifurcation and recurrent aneurysms with high packing rates. While described in extenso for laser cut stents, the results of patients treated with the Leo+ Baby (Balt, Montmorency, France) braided microstent are presented. Material and Methods: Patients were included if treated with a Leo+ Baby and with digital subtraction angiography (DSA) follow-up available of at least 6 months. Data were evaluated for successful deployment, aneurysm occlusion according to the modified Raymond-Roy classification (MRRC), stent patency and procedure-related morbidity and mortality. Results: A total of 81 patients were included and Leo+ Baby deployment was successful in all cases. Coils were used in 80 cases. In 1 case 2 stents were used stent-in-stent without additional coiling. Initial aneurysm occlusion rates were MRRCi1 51.9%, MRRCi2 11.1%, MRRCi3a 24.7% and MRRCi3b 12.3%. Occlusion rates after 6 months were MRRC6m1 78.9%, MRRC6m2 3.9%, MRRC6m3a 6.6% and MRRC6m3b 10.5%. Procedure-related morbidity was 1 case of acute stent thrombosis successfully treated with tirofiban and 1 case with transient hemiparesis due to stent thrombosis after 4 months. There was 1 case of coil-associated subarachnoid hemorrhage (SAH) which caused prolonged hospitalization. No procedure-related mortality was observed. Conclusion: The results confirm that stent-assisted coiling with the Leo+ Baby stent is safe and efficient for treatment of wide neck or recurrent cerebral aneurysms. Spontaneous progressive aneurysm occlusion over 6 months supports the theory of considerable flow-modulating effects of Leo+ Baby.
CRIS-Team Scopus Importer:2020-05-15
Keywords: Bifurcation aneurysm; Braided stent; Cerebral aneurysm; Coiling; Low profile stent

Stent evaluation in low-dose coronary CT angiography: Effect of different iterative reconstruction settings - Wüst, Wolfgang; May, Matthias; Scharf, Michael; Layritz, Christian; Eisentopf, Jasmin; Ropers, Dieter; Pflederer, Tobias; Uder, Michael; Achenbach, Stephan; Lell, Michael (Journal of Cardiovascular Computed Tomography, 2013)
Background: Different iterative reconstruction (IR) techniques compensate increased noise from lower tube current-time product settings, yet the differences between IR settings remain unclear. Objective: Aim of this study was to test whether different IR settings have a clinically relevant influence on image quality and on the diagnostic accuracy of low-dose CT angiography in patients with a stent. Methods: Forty-two patients with 73 coronary stents were prospectively enrolled. Data were acquired with dual-source CT, and images were reconstructed with standard filtered back projection (FBP) and raw data-based IR with different settings (I3, I4, I5). Quantitative parameters, including CT-attenuation, noise, signal-to-noise ratio, contrast-to-noise ratio, as well as the presence of in-stent stenosis > 50% were determined. All patients had invasive angiography as reference standard. Results: Mean effective dose was 0.32 ± 0.02 mSv. Image noise decreased significantly compared with FBP (I3= 29%; I4= 38% and I5= 45%), whereas signal-to-noise and contrast-to-noise ratios increased significantly (all IR settings P <.01). Subjective image quality was superior with all IR settings (P < .01). FBP sensitivity, specificity, positive predictive value, and negative predictive value were 83%, 71%, 36%, and 96% per stent compared with 100%, 76%, 44%, and 100%, respectively, in IR reconstructions independent of the IR setting applied. Conclusion: In low-dose coronary CT angiography, higher IR settings significantly improved subjective and objective image quality but had no effect on accuracy. © 2013 Society of Cardiovascular Computed Tomography.
CRIS-Team Scopus Importer:2023-03-08
Keywords: Cardiac CT; Coronary stents; Iterative reconstruction; Low dose; SAFIRE

Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause - Büstgens, Felix; Loose, Reinhard; Ficker, Joachim H.; Wucherer, Michael; Uder, Michael; Adamus, Ralf (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2017)
Purpose The purpose of this paper is the retrospective analysis of endovascular therapy for the treatment of superior vena cava syndrome (SVCS) of malignant cause. This study focuses on the effectiveness of the therapy regarding the duration of remission, symptom control and practicability. Materials and Methods From January 2003 to November 2012, therapeutic implantation of one or more stents was performed in 141 patients suffering from SVCS. The medical history was retrospectively researched using digitalized patient files. If those were incomplete, secondary research was conducted using the cancer registry of the General Hospital Nuremberg, the cancer registry of the tumor center at Friedrich-Alexander-University Erlangen-Nuremberg (FAU) or information given by physicians in private practice. This data was collected using Microsoft Office Excel(®) and statistically analyzed using IBM SPSS Statistics 22(®). Results 168 stents were implanted in 141 patients (median age: 64.6 years; range: 36 - 84), 86 being male and 55 being female. In 121 patients, SVCS was caused by lung cancer (85.8 %), in 9 patients by mediastinal metastasis of an extrathoracic carcinoma (6.4 %), in 3 patients by mesothelioma of the pleura (2.1 %) and in 1 patient by Hodgkin's disease (0.7 %). There was no histological diagnosis in 7 cases (4.9 %). The primary intervention was successful in 138 patients (97.9 %). Immediate thrombosis in the stent occurred in the remaining 3 cases. Recurrence of SVCS was observed in 22 patients (15.6 %), including 5 early and 17 late occlusions. Stent dislocation or breakage was not observed. As expected, the survival after implantation was poor. The median survival was 101 days, and the median occlusion-free survival was 80 days. Conclusion The symptomatic therapy of SVCS with endovascular stents is effective and safe. Despite effective symptom control and a low rate of recurrence, the patients' prognosis is poor. Key Points: · Patients with SVCS of malignant cause have a poor prognosis.. · Lung cancer is the most common cause for SVCS.. · Endovascular therapy is safe and effective.. Citation Format · Büstgens FA, Loose R, Ficker JH et al. Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause. Fortschr Röntgenstr 2017; 189: 423 - 430.
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Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study - Hart, Harvi F.; Gross, K. Douglas; Crossley, Kay M.; Barton, Christian J.; Felson, David T.; Guermazi, Ali; Roemer, Frank; Segal, Neil A.; Lewis, Cora E.; Nevitt, Michael C.; Stefanik, Joshua J. (Arthritis & Rheumatism-Arthritis Care & Research, 2020)
Objective: To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. Methods: The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. Results: A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2, and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1–3.8]) and TF (RR 1.8 [95% CI 1.1–2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1–3.9]). Conclusion: Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.
CRIS-Team Scopus Importer:2020-01-07

Stereotactic vacuum-assisted breast biopsy (VABB)–a patients' survey - Eller, Achim; Janka, Rolf Matthias; Lux, Michael P.; Saake, Marc; Schulz-Wendtland, Rüdiger; Uder, Michael; Wenkel, Evelyn (Anticancer Research, 2014)
To analyze how patients experience Stereotactic guided vacuum-assisted breast biopsy (VABB) both physically and mentally.Two hundred and eleven consecutive women underwent VABB using one of two different biopsy devices (ATEC® and Mammotome®). Patients were queried using a questionnaire.One hundred and eighty-nine patients were included. 90% would again prefer VABB over a surgical biopsy. Average grading for the condition during the procedure was 2.5 (very good to good) and 2.1 (very good) for the condition the week following VABB. Minor complications were mentioned in 37%. (>90% pain and hematoma). 97% of the women were satisfied by the cosmetic results. Patients with malignant histology and younger age experienced the procedure significantly worse. A significant higher rate of minor complications was found in younger patients and in the ATEC® group.VABB is a physical and mental stressor to the women. Nonetheless, the majority of women indeed prefer the VABB.
EVALuna2:14365

Stimulated echo double diffusion encoded imaging of closed pores: Influence and removal of unbalanced terms - Demberg, Kerstin; Bachert, Peter; Ladd, Mark Edward; Kuder, Tristan Anselm; Laun, Frederik Bernd (Physical Review E, 2019)
Nuclear magnetic resonance (NMR) diffusion pore imaging has been proposed to study the shape of arbitrary closed pores filled with an NMR-detectable medium by use of nonclassical diffusion encoding schemes. Potential applications can be found in biomedical imaging and porous media research. When studying non-point-symmetric pores, NMR signals with nonvanishing imaginary parts arise containing the pore shape information, which is lost for classical diffusion encoding schemes. Key limitations are the required high magnetic field gradient amplitudes and T2 relaxation while approaching the diffusion long-time limit. To benefit from the slower T1 decay, we demonstrate the feasibility of diffusion pore imaging with stimulated echoes using Monte Carlo simulations and experiments with hyperpolarized xenon-129 gas in well-defined geometries and show that the necessary complex-valued signals can be acquired. Analytical derivation of the stimulated echo double diffusion encoded signal was performed to investigate the effect of the additionally arising undesired terms on the complex phase information. These terms correspond to signals arising for spin-echo sequences with unbalanced gradients. For most possible applications, the unbalanced terms can be neglected. If non-negligible, selection of the appropriate signal component using a phase cycling scheme was demonstrated experimentally. Using stimulated echoes may be a step towards application of diffusion pore imaging to larger pores with gradient amplitudes available today in preclinical systems.
CRIS-Team WoS Importer:2019-10-25

Strategic application of imaging in DMOAD clinical trials: focus on eligibility, drug delivery, and semiquantitative assessment of structural progression - Guermazi, Ali; Roemer, Frank; Crema, Michel D.; Jarraya, Mohamed; Mobasheri, Ali; Hayashi, Daichi (Therapeutic Advances in Musculoskeletal Disease, 2023)
Despite decades of research efforts and multiple clinical trials aimed at discovering efficacious disease-modifying osteoarthritis (OA) drugs (DMOAD), we still do not have a drug that shows convincing scientific evidence to be approved as an effective DMOAD. It has been suggested these DMOAD clinical trials were in part unsuccessful since eligibility criteria and imaging-based outcome evaluation were solely based on conventional radiography. The OA research community has been aware of the limitations of conventional radiography being used as a primary imaging modality for eligibility and efficacy assessment in DMOAD trials. An imaging modality for DMOAD trials should be able to depict soft tissue and osseous pathologies that are relevant to OA disease progression and clinical manifestations of OA. Magnetic resonance imaging (MRI) fulfills these criteria and advances in technology and increasing knowledge regarding imaging outcomes likely should play a more prominent role in DMOAD clinical trials. In this perspective article, we will describe MRI-based tools and analytic methods that can be applied to DMOAD clinical trials with a particular emphasis on knee OA. MRI should be the modality of choice for eligibility screening and outcome assessment. Optimal MRI pulse sequences must be chosen to visualize specific features of OA.
CRIS-Team Scopus Importer:2023-04-28
Keywords: clinical trial; disease-modifying osteoarthritis drugs; imaging; knee osteoarthritis; MRI

Streptococcal toxic shock syndrome with associated necrotising fasciitis necessitating amputation of the lower extremity – A case report - Strecker, Thomas; Treutlein, Christoph; Agaimy, Abbas; Wehrfritz, Andreas (SAGE Open Medical Case Reports, 2023)
Streptococcal toxic shock syndrome is a severe, invasive and life-threatening infection associated with a high risk of rapid multiorgan failure. It is associated with high morbidity and mortality. Streptococcal toxic shock syndrome is very commonly caused by group A-Streptococcus pyogenes, ß-haemolytic streptococcus, a typical human-specific gram-positive bacterial pathogen. We present here the case report of a 54-year-old man with a rapidly progressive streptococcal toxic shock syndrome due to necrotising fasciitis of the left lower limb and describe the successful treatment through close interdisciplinary care.
CRIS-Team Scopus Importer:2023-10-27
Keywords: amputation; computer tomography; group A-Streptococcus pyogenes; necrotising fasciitis; Streptococcal toxic shock syndrome; β-haemolytic streptococcus

Stress fractures - Current recommendations and principles for diagnosis and therapy Problemdiagnose Stressfraktur – Aktuelle Empfehlungen und Prinzipien zur Diagnostik und Therapie - Heiß, Rafael; Lutter, Christoph; Kastner, Tom; Janka, Rolf Matthias; Uder, Michael; Hotfiel, Thilo (Sport-Orthopädie, Sport-Traumatologie, 2022)
Stress fractures and stress reactions are among the injuries caused by overuse (“overuse injuries”) and can result in significant training and competition failures for affected athletes. Repetitive load effects that exceed the ability to cope with stress and adaptability, combined with intrinsic and extrinsic risk factors or tactical training errors, are considered to be the main cause of stress fractures. These and possible accompanying individual risk profiles are diverse and require complex and often interdisciplinary care. The majority of stress fractures heal easily and the recovery of full performance and resilience is usually given. However, if the diagnosis is delayed or inadequate (some injury entities require consistent decision-making regarding surgical therapy) or if secondary risk factors are not taken into account, prolonged healing processes, recurrent injuries or even multiple injury locations can occur at the same time. An early diagnosis and the beginning of a stage-appropriate therapy, including the consideration of existing risk factors, are therefore of essential importance.
CRIS-Team Scopus Importer:2022-03-11
Keywords: Marching fracture; MRI; Running injury; Stress fracture; Stress reaction; X-ray

Structural brain imaging - Kälviäinen, Reetta; Dörfler, Arnd (Elsevier B.V., 2012)
CRIS-Team Scopus Importer:2022-08-05

STRUCTURAL EFFECTS OF INTRA-ARTICULAR SPRIFERMIN IN SYMPTOMATIC RADIOGRAPHIC KNEE OSTEOARTHRITIS: A POST-HOC ANALYSIS OF CARTILAGE AND NON-CARTILAGINOUS TISSUE ALTERATIONS OF THE 2-YEAR DATA FROM A 5-YEAR RANDOMISED, PLACEBO-CONTROLLED, PHASE II STUDY - Roemer, Frank; Kraines, J.; Aydemir, A.; Wax, S.; Crema, M.; Hochberg, M.; Guermazi, A. (2018)
EVALuna2:36247

Structural Effects of Intra-Articular Sprifermin in Symptomatic Radiographic Knee Osteoarthritis: A Post-Hoc Analysis of Cartilage Morphology over the 2-Year Treatment-Period of a 5-Year Randomized, Placebo-Controlled, Phase II Study - Guermazi, Ali; Kraines, Jeffrey; Aydemir, Aida; Wax, Stephen; Crema, Michel; Hochberg, Marc C.; Roemer, Frank (2018)
EVALuna2:36236

Structural effects of intra-articular TGF-β1 in moderate to advanced knee osteoarthritis: MRI-based assessment in a randomized controlled trial - Guermazi, A.; Kalsi, G.; Niu, J.; Crema, M. D.; Copeland, R. O.; Orlando, A.; Noh, M. J.; Roemer, Frank (BMC Musculoskeletal Disorders, 2017)
To determine effects of allogeneic human chondrocytes expressing TGF-?1 (TG-C) on structural progression of MRI features of knee osteoarthritis over a 1 year period.This phase II randomized controlled trial of TG-C included patients with moderate to advanced osteoarthritis. Patients were randomized to receive an intraarticular 3:1 mixture of non-transduced allogeneic human chondrocytes and TG-C or placebo. 3 T MRI was acquired for all patients at baseline and follow-up (3, 6 and 12 months). MRIs were assessed using the WORMS system including cartilage damage, bone marrow lesions (BMLs), meniscal damage/extrusion, Hoffa-, effusion-synovitis, and osteophytes. Analyses were performed on a whole knee level, compartmental level, and subregional level. Binary logistic regression with Generalized Estimating Equation was used to compare risks of progression, adjusting for baseline age and gender. Mann - Whitney - Wilcoxon tests were used to assess differences for continuous variables.Fifty-seven Patients were included in the TG-C group and 29 in the placebo group. At 12 months, knees in the TG-C group showed less progression of cartilage damage compared to placebo on a whole knee level (34.6% vs. 47.9%; adjusted RR 0.7, 95%CI [0.5-1.1], p = 0.077). Less progression of Hoffa-synovitis and effusion-synovitis was observed in the TG-C group compared to placebo (9.6% vs. 21.1%, adjusted RR 0.5, 95%CI [0.2,1.2], p = 0.115). No statistically significant differences were seen for BMLs, meniscal damage and osteophytes.Intraarticular treatment with TG-C showed fewer patients in the treated group with progression in structural OA features and other MRI-defined inflammatory markers such as Hoffa-synovitis and effusion-synovitis. However, no differences were observed in regard to progression of BMLs and meniscal damage, or hypertrophic osteophyte formation.NCT01221441 .Registered 13th October, 2010.
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Structural effects of sprifermin in knee osteoarthritis: a post-hoc analysis on cartilage and non-cartilaginous tissue alterations in a randomized controlled trial - Roemer, Frank; Aydemir, Aida; Lohmander, Stefan; Crema, Michel D.; Marra, Monica Dias; Muurahainen, Norma; Felson, David T.; Eckstein, Felix; Guermazi, Ali (BMC Musculoskeletal Disorders, 2016)
A recent publication on efficacy of Sprifermin for knee osteoarthritis (OA) using quantitatively MRI-defined central medial tibio-femoral compartment cartilage thickness as the structural primary endpoint reported no statistically significant dose response. However, Sprifermin was associated with statistically significant, dose-dependent reductions in loss of total and lateral tibio-femoral cartilage thickness. Based on these preliminary promising data a post-hoc analysis of secondary assessment and endpoints was performed to evaluate potential effects of Sprifermin on semi-quantitatively evaluated structural MRI parameters. Aim of the present analysis was to determine effects of sprifermin on several knee joint tissues over a 12 month period.1.5 T or 3 T MRIs were acquired at baseline and 12 months follow-up using a standard protocol. MRIs were read according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring system (in 14 articular subregions) by four muskuloskeletal radiologists independently. Analyses focused on semiquantitative changes in the 100 ?g subgroup and matching placebo of multiple MRI-defined structural alterations. Analyses included a delta-subregional and delta-sum approach for the whole knee and the medial and lateral tibio-femoral (MTFJ, LTFJ), and patello-femoral (PFJ) compartments, taking into account number of subregions showing no change, improvement or worsening and changes in the sum of subregional scores. Mann-Whitney - Wilcoxon tests assessed differences between groups.Fifty-seven and 18 patients were included in the treatment and matched placebo subgroups. Less worsening of cartilage damage was observed from baseline to 12 months in the PFJ (0.02, 95 % confidence interval (CI) (-0.04, 0.08) vs. placebo 0.22, 95 % CI (-0.05, 0.49), p = 0.046). For bone marrow lesions (BMLs), more improvement was observed from 6 to 12 months for whole knee analyses (-0.14, 95 % CI (-0.48, 0.19) vs. placebo 0.44, 95 % CI (-0.15, 1.04), p = 0.042) although no significant effects were seen from the baseline visit, or in Hoffa-synovitis, effusion-synovitis, menisci and osteophytes.In this post-hoc analysis cartilage showed less worsening from baseline to 12 months in the PFJ, and BMLs showed more improvement from 6 to 12 months for the whole knee.ClinicalTrials.gov identifier: NCT01033994 .
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Structural phenotypes of knee osteoarthritis: potential clinical and research relevance - Roemer, Frank; Jarraya, Mohamed; Collins, Jamie E.; Kwoh, C. Kent; Hayashi, Daichi; Hunter, David J.; Guermazi, Ali (Skeletal Radiology, 2022)
A joint contains many different tissues that can exhibit pathological changes, providing many potential targets for treatment. Researchers are increasingly suggesting that osteoarthritis (OA) comprises several phenotypes or subpopulations. Consequently, a treatment for OA that targets only one pathophysiologic abnormality is unlikely to be similarly efficacious in preventing or delaying the progression of all the different phenotypes of structural OA. Five structural phenotypes have been proposed, namely the inflammatory, meniscus-cartilage, subchondral bone, and atrophic and hypertrophic phenotypes. The inflammatory phenotype is characterized by marked synovitis and/or joint effusion, while the meniscus-cartilage phenotype exhibits severe meniscal and cartilage damage. Large bone marrow lesions characterize the subchondral bone phenotype. The hypertrophic and atrophic OA phenotype are defined based on the presence large osteophytes or absence of any osteophytes, respectively, in the presence of concomitant cartilage damage. Limitations of the concept of structural phenotyping are that they are not mutually exclusive and that more than one phenotype may be present. It must be acknowledged that a wide range of views exist on how best to operationalize the concept of structural OA phenotypes and that the concept of structural phenotypic characterization is still in its infancy. Structural phenotypic stratification, however, may result in more targeted trial populations with successful outcomes and practitioners need to be aware of the heterogeneity of the disease to personalize their treatment recommendations for an individual patient. Radiologists should be able to define a joint at risk for progression based on the predominant phenotype present at different disease stages.
CRIS-Team WoS Importer:2022-10-14

Structural tissue damage and 24-month progression of semi-quantitative MRI biomarkers of knee osteoarthritis in the IMI-APPROACH cohort - Roemer, Frank; Jansen, Mylene; Marijnissen, Anne C. A.; Guermazi, Ali; Heiß, Rafael; Maschek, Susanne; Lalande, Agnes; Blanco, Francisco J.; Berenbaum, Francis; Van De Stadt, Lotte A.; Kloppenburg, Margreet; Haugen, Ida K.; et al. (BMC Musculoskeletal Disorders, 2022)
Background: The IMI-APPROACH cohort is an exploratory, 5-centre, 2-year prospective follow-up study of knee osteoarthritis (OA). Aim was to describe baseline multi-tissue semiquantitative MRI evaluation of index knees and to describe change for different MRI features based on number of subregion-approaches and change in maximum grades over a 24-month period. Methods: MRIs were acquired using 1.5 T or 3 T MRI systems and assessed using the semi-quantitative MRI OA Knee Scoring (MOAKS) system. MRIs were read at baseline and 24-months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. In descriptive fashion, the frequencies of MRI features at baseline and change in these imaging biomarkers over time are presented for the entire sample in a subregional and maximum score approach for most features. Differences between knees without and with structural radiographic (R) OA are analyzed in addition. Results: Two hundred eighty-nine participants had readable baseline MRI examinations. Mean age was 66.6 ± 7.1 years and participants had a mean BMI of 28.1 ± 5.3 kg/m2. The majority (55.3%) of included knees had radiographic OA. Any change in total cartilage MOAKS score was observed in 53.1% considering full-grade changes only, and in 73.9% including full-grade and within-grade changes. Any medial cartilage progression was seen in 23.9% and any lateral progression on 22.1%. While for the medial and lateral compartments numbers of subregions with improvement and worsening of BMLs were very similar, for the PFJ more improvement was observed compared to worsening (15.5% vs. 9.0%). Including within grade changes, the number of knees showing BML worsening increased from 42.2% to 55.6%. While for some features 24-months change was rare, frequency of change was much more common in knees with vs. without ROA (e.g. worsening of total MOAKS score cartilage in 68.4% of ROA knees vs. 36.7% of no-ROA knees, and 60.7% vs. 21.8% for an increase in maximum BML score per knee). Conclusions: A wide range of MRI-detected structural pathologies was present in the IMI-APPROACH cohort. Baseline prevalence and change of features was substantially more common in the ROA subgroup compared to the knees without ROA. Trial Registration: Clinicaltrials.gov identification: NCT03883568.
CRIS-Team Scopus Importer:2022-12-02
Keywords: Knee; MRI; Osteoarthritis; Progression; reliability

Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value - Kopp, Markus; Wetzl, Matthias; Geißler, Frederik; Roth, Jessica; Wallner, R.; Hoefler, D.; Faby, S.; Allmendinger, T.; Amarteifio, P.; Wüst, Wolfgang; Uder, Michael; May, Matthias; et al. (Journal of Medical Systems, 2021)
The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.
CRIS-Team Scopus Importer:2021-02-05
Keywords: Computed tomography; Digital informed patient consent; Digital medical history; Mobile devices; Structured anamnesis

Study on the Impact of CMV-Encephalopathy on the Survival of Brain Cancer Patients Undergoing Radio(Chemo) therapy of the Brain - Goerig, Nicole; Frey, Benjamin; Korn, Klaus; Fleckenstein, Bernhard; Überla, Klaus; Schmidt, M. A.; Engelhorn, Tobias; Dörfler, Arnd; Eyüpoglu, Ilker Yasin; Merkel, Andreas; Rühle, Paul-Friedrich; Putz, F.; et al. (2017)
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Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: a cross-sectional and longitudinal analysis - Faustini, Francesca; Simon, Dominic; Oliveira, Isabelle; Kleyer, Arnd; Haschka, Judith; Englbrecht, Matthias; Cavalcante, Alan Rodrigues; Kraus, Sebastian; Tabosa, Taiane Ponte; Figueiredo, Camille; Hueber, Axel; Kocijan, Roland; et al. (Annals of the Rheumatic Diseases, 2016)
To search for subclinical inflammatory joint disease in patients with psoriasis without psoriatic arthritis (PsA), and to determine whether such changes are associated with the later development of PsA.Eighty-five subjects without arthritis (55 with psoriasis and 30 healthy controls) received high field MRI of the hand. MRI scans were scored for synovitis, osteitis, tenosynovitis and periarticular inflammation according to the PsAMRIS method. Patients with psoriasis additionally received complete clinical investigation, high-resolution peripheral quantitative CT for detecting erosions and enthesiophytes and were followed up for at least 1 year for the development of PsA.47% of patients with psoriasis showed at least one inflammatory lesion on MRI. Synovitis was the most prevalent inflammatory lesion (38%), while osteitis (11%), tenosynovitis (4%) and periarticular inflammation (4%) were less frequent. The mean (±SD) PsAMRIS synovitis score was 3.0±2.5 units. Enthesiophytes and bone erosions were not different between patients with psoriasis with or without inflammatory MRI changes. The risk for developing PsA was as high as 60% if patients had subclinical synovitis and symptoms related to arthralgia, but only 13% if patients had normal MRIs and did not report arthralgia.Prevalence of subclinical inflammatory lesions is high in patients with cutaneous psoriasis. Arthralgia in conjunction with MRI synovitis constitutes a high-risk constellation for the development of PsA.
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SUBCLINICAL MRI INFLAMMATION DOES NOT PREDICT RELAPSE RISK IN RHEUMATOID ARTHRITIS PATIENTS TAPERING DMARDS - Doliveira, I.; Mensing, W.; Figueiredo, C.; Englbrecht, Matthias; Haschka, J.; Hueber, Axel; Kleyer, Arnd; Schett, Georg; Rech, Jürgen; Cavallaro, Alexander Josef (2016)
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SUBREGIONAL ANATOMICAL PREVALENCE OF CARTILAGE DAMAGE IN KNEES WITH RADIOGRAPHIC DISEASE SEVERITY KELLGREN-LAWRENCE 2 AND 3: THE MOST STUDY - Roemer, Frank; Felson, D. T.; Stefanik, J. J.; Rabasa, G.; Wang, N.; Crema, M.; Neogi, T.; Lynch, J. A.; Nevitt, M. C.; Torner, J.; Lewis, C. E.; Guermazi, A. (OSTEOARTHRITIS AND CARTILAGE, 2021)
CRIS-Team WoS Importer:2021-05-21

Successful Surgery of Exophytic Brainstem Glioma Mimicking Cerebellar-Pontine Angle Tumor: Case Report and Review of Literature - Roessler, Karl; Heynold, Elisabeth; Coras, Roland; Lücking, Hannes; Buchfelder, Michael (World Neurosurgery, 2019)
Background: Nontectal plate exophytic brainstem gliomas with pilocytic histology are rare and occur mainly in children. Because of their eloquent location, therapy usually consists of bioptic histologic verification and radiotherapy in case of progression. Case Description: We report on a 43-year-old patient who presented with intermittent tinnitus and reduced hearing in his left ear, as well as a slight left-sided ataxia. Magnetic resonance imaging revealed a left-sided solid cystic cerebellar-pontine angle (CPA) tumor completely obliterating the CPA. Radiologically, a solid cystic vestibular schwannoma was diagnosed. Intraoperatively, a glossy-grayish, intensively bleeding tumor without any capsule or delineation to the brainstem or cranial nerves was resected using electrophysiologic monitoring. Postoperative histology revealed a pilocytic astrocytoma. Three months postoperatively, hearing was preserved (pure tone average—35 dB) and ataxia was equal to what it was preoperatively, gradually becoming better. Postoperative magnetic resonance scans demonstrated a complete resection of the tumor with completely restored brainstem contours. Conclusions: Exophytic brainstem gliomas may occur in the CPA and mimic vestibular schwannoma. Complete resection even with preserved hearing without neurologic deterioration may be feasible.
EVALuna2:204027
Keywords: Cerebellar-pontine angle; Complete resection; Pilocytic astrocytoma; Vestibular schwannoma hearing preservation

Successful treatment of a patient with middle aortic syndrome and renovisceral involvement using aorto-aortic bypass: case report and review of recent literature - Meyer, Alexander; Kuefner, Michael A.; Schmid, Andrea; Heinz, Marco; Lang, Werner (Annals of Vascular Surgery, 2014)
Middle aortic syndrome (MAS), defined as localized abdominal or thoracic aortic hypoplasia, represents an extraordinary rare condition, often diagnosed in younger patients with severe renal hypertension. Etiology is divided into congenital and acquired causes (e.g., Takayasu disease). Because of its extremely unfavorable course, treatment of symptomatic patients is mandatory, whereas open surgery with aorto-aortic bypass or patch aortoplasty is considered the standard therapy. This report describes a case of a 19-year-old Macedonian woman presenting with MAS and renal hypertension who was successfully treated with aorto-aortic bypass, including reconstruction of both renal and the hepatic and superior mesenteric arteries, and reviews the current literature.
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Sulfasalazine impacts on ferroptotic cell death and alleviates the tumor microenvironment and glioma-induced brain edema. - Sehm, Tina; Fan, Zheng; Ghoochani, Ali; Rauh, Manfred; Engelhorn, Tobias; Minakaki, Georgia; Dörfler, Arnd; Klucken, Jochen; Buchfelder, Michael; Eyüpoglu, Ilker Yasin; Savaskan, Nicolai (Oncotarget, 2016)
The glutamate transporter xCT (SCL7a11, system Xc-, SXC) is an emerging key player in glutamate/cysteine/glutathione homeostasis in the brain and in cancer. xCT expression correlates with the grade of malignancy. Here, we report on the use of the U.S. Food and Drug Administration and EMA-approved xCT inhibitor, sulfasalazine (SAS) in gliomas. SAS does not affect cell viability in gliomas at concentrations below 200 µM. At higher concentrations SAS becomes gliomatoxic. Mechanistically SAS inhibits xCT and induces ferroptotic cell death in glioma cells. There is no evidence for impact on autophagic flux following SAS application. However, SAS can potentiate the efficacy of the standard chemotherapeutic and autophagy-inducing agent temozolomide (Temcat, Temodal or Temodar®). We also investigated SAS in non-transformed cellular constituents of the brain. Neurons and brain tissue are almost non-responding to SAS whereas isolated astrocytes are less sensitive towards SAS toxicity compared to gliomas. In vivo SAS treatment does not affect experimental tumor growth and treated animals revealed comparable tumor volume as untreated controls. However, SAS treatment resulted in reduced glioma-derived edema and, hence, total tumor volume burden as revealed by T2-weighted magnetic resonance imaging. Altogether, we show that SAS can be utilized for targeting the glutamate antiporter xCT activity as a tumor microenvironment-normalizing drug, while crucial cytotoxic effects in brain tumors are minor.

Superolateral Hoffa's fat pad (SHFP) oedema and patellar cartilage volume loss: quantitative analysis using longitudinal data from the Foundation for the National Institute of Health (FNIH) Osteoarthritis Biomarkers Consortium - Haj-Mirzaian, Arya; Guermazi, Ali; Hafezi-Nejad, Nima; Sereni, Christopher; Hakky, Michael; Hunter, David J.; Zikria, Bashir; Roemer, Frank; Demehri, Shadpour (European Radiology, 2018)
OBJECTIVES: To determine the association of superolateral Hoffa's fat pad (SHFP) oedema and patellofemoral joint structural damage in participants of Foundation for the National Institute of Health Osteoarthritis Biomarkers Consortium study. METHODS: Baseline and 24-month MRIs of 600 subjects were assessed. The presence of SHFP oedema (using 0-3 grading scale) and patellar morphology metrics were determined using baseline MRI. Quantitative patellar cartilage volume and semi-quantitative MRI osteoarthritis knee score (MOAKS) variables were extracted. The associations between SHFP oedema and patellar cartilage damage, bone marrow lesion (BML), osteophyte and morphology were evaluated in cross-sectional model. In longitudinal analysis, the associations between oedema and cartilage volume loss (defined using reliable change index) and MOAKS worsening were evaluated. RESULTS: In cross-sectional evaluations, the presence of SHFP oedema was associated with simultaneous lateral patellar cartilage/BML defects and inferior-medial patellar osteophyte size. A significant positive correlation between the degree of patella alta and SHFP oedema was detected (r = 0.259, p < 0.001). The presence of oedema was associated with 24-month cartilage volume loss (odds ratio (OR) 2.11, 95% confidence interval 1.46-3.06) and medial patellar BML size (OR 1.92 (1.15-3.21)) and number (OR 2.50 (1.29-4.88)) worsening. The optimal cut-off value for the grade of baseline SHFP oedema regarding both presence and worsening of patellar structural damage was ≥ 1 (presence of any SHFP hyperintensity). CONCLUSIONS: The presence of SHFP oedema could be considered as a predictor of future patellar cartilage loss and BML worsening, and an indicator of simultaneous cartilage, BML and osteophyte defects. KEY POINTS: • SHFP oedema was associated with simultaneous lateral patellar OA-related structural damage. • SHFP oedema was associated with longitudinal patellar cartilage loss over 24 months. • SHFP oedema could be considered as indicator and predictor of patellar OA.
EVALuna2:35375

Super-Resolution for CEST MRI - Folle, Lukas; Tkotz, Katharina; Liebert, Andrzej; Gadjimuradov, Fasil; Kapsner, Lorenz; Fabian, Moritz; Bickelhaupt, Sebastian; Simon, David; Kleyer, Arnd; Krönke, Gerhard; Roemer, Frank; Zaiß, Moritz; et al. (Joint annual meeting ISMRM-ESMRMB ISMRT, 2022)
The resolution of chemical exchange saturation transfer (CEST) magnetic resonance imaging is limited by physical constraints. To visualize metabolic processes of small structures using CEST in patients knees, an increased resolution is necessary. In this work, we compared trilinear interpolation and zero-filling to neural network-based approaches to estimate a high-resolution image given the corresponding low-resolution data. We could show that a substantial quantitative improvement using neural networks could be achieved for unsaturated images while maintaining a comparable CEST contrast. Generalization of the method to brain CEST MRI was achieved without retraining of the networ
Keywords: MRI; Super-resolution

Suppression of proatherogenic leukocyte interactions by MCS-18 - Impact on advanced atherosclerosis in ApoE-deficient mice - Kühn, Constanze; Tauchi, Miyuki; Stumpf, Christian; Daniel, Christoph; Bäuerle, Tobias; Schwarz, Marc; Kerek, Franz; Steinkasserer, Alexander; Zinser, Elisabeth; Achenbach, Stephan; Dietel, Barbara (Atherosclerosis, 2016)
Atherosclerosis is associated with chronic inflammatory responses of the arterial blood vessels. The previously observed protective effect of the MCS-18 substance against the initiation of atherosclerosis in a murine model was explained by its pronounced anti-inflammatory activity. Here, we investigated its impact on murine plaque progression in advanced atherosclerosis and on proatherogenic processes.ApoE-deficient mice were fed a high-fat diet for 12 weeks to induce atherosclerosis, followed by normal chow and intraperitoneal injections of either MCS-18 (500 ?g, n = 10) or saline (n = 10) twice a week for another 12 weeks. Plaque size was reduced in MCS-18 treated mice compared to controls (p = 0.001), which was associated with a reduced size of the lipid core (p = 0.01). There was a decrease in apoptotic cells (p = 0.02), endothelial ICAM-1 expression (p < 0.001), and macrophage density (p = 0.01) in the MCS-18 group. In addition, human and murine dendritic cells (DCs) and human umbilical vein endothelial cells (HUVECs) were treated with MCS-18 (50-200 ?g/ml) to analyze cell migration and adhesion under flow conditions. MCS-18 reduced human (p = 0.01) and murine (p = 0.006) DC migration. Furthermore, adhesion of MCS-18-treated DCs to a HUVEC monolayer was decreased (p < 0.001). Compared to controls, CD209 (p < 0.001) and CCR7 (p = 0.003) expression was decreased in MCS-18-treated DCs, while in HUVECs lower levels of ICAM-1 (p < 0.001) and of phosphorylated NF-?B-p65 (p = 0.002) were observed. Blocking of ICAM-1 reduced DC adhesion (p < 0.001).MCS-18 exhibits interesting therapeutic effects when applied in advanced murine atherosclerosis. Its antiatherogenic impact might be associated with a suppressed adhesion to the endothelium due to down-regulation of endothelial ICAM-1 expression.
EVALuna2:12031

Supratentorial lesions contribute to trigeminal neuralgia in multiple sclerosis - Fröhlich, Katharina; Winder, Klemens; Linker, Ralf; Engelhorn, Tobias; Dörfler, Arnd; Lee, De-Hyung; Hilz, Max-Josef; Schwab, Stefan; Seifert, Frank (Cephalalgia, 2018)
Background It has been proposed that multiple sclerosis lesions afflicting the pontine trigeminal afferents contribute to trigeminal neuralgia in multiple sclerosis. So far, there are no imaging studies that have evaluated interactions between supratentorial lesions and trigeminal neuralgia in multiple sclerosis patients. Methods We conducted a retrospective study and sought multiple sclerosis patients with trigeminal neuralgia and controls in a local database. Multiple sclerosis lesions were manually outlined and transformed into stereotaxic space. We determined the lesion overlap and performed a voxel-wise subtraction analysis. Secondly, we conducted a voxel-wise non-parametric analysis using the Liebermeister test. Results From 12,210 multiple sclerosis patient records screened, we identified 41 patients with trigeminal neuralgia. The voxel-wise subtraction analysis yielded associations between trigeminal neuralgia and multiple sclerosis lesions in the pontine trigeminal afferents, as well as larger supratentorial lesion clusters in the contralateral insula and hippocampus. The non-parametric statistical analysis using the Liebermeister test yielded similar areas to be associated with multiple sclerosis-related trigeminal neuralgia. Conclusions Our study confirms previous data on associations between multiple sclerosis-related trigeminal neuralgia and pontine lesions, and showed for the first time an association with lesions in the insular region, a region involved in pain processing and endogenous pain modulation.
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Surgical hematoma evacuation of cortical intracerebral hemorrhage ≥10 ml reduces risk of subsequent epilepsy by more than 70%: A retrospective monocenter study - Welte, Tamara; Steidl, Josephine; Stritzelberger, Jenny; Gollwitzer, Stephanie; Lang, Johannes; Reindl, Caroline; Rampp, Stefan; Maslarova, Anna; Brandner, Sebastian; Hock, Stefan; Mühlen, Iris; Dörfler, Arnd; et al. (European Journal of Neurology, 2022)
Aim: The aim of this study was to re-evaluate risk factors for post-ICH epilepsy (PICHE) and examine the impact of surgical hematoma evacuation on epilepsy development after ICH. Background and purpose: Epilepsy is a common complication after intracerebral hemorrhage (ICH). Information on risk factors is still scarce and the role of ICH evacuation remains uncertain. Methods: We retrospectively included patients with spontaneous ICH treated in our hospital in 2006–2019. Patients' medical records were analyzed. In addition, mailed questionnaires and telephone interviews were used to complete the dataset. Uni- and multivariable hazard ratios (HRs) were applied to investigate risk factors for PICHE and the impact of surgical ICH evacuation. Results: Among 587 ICH patients available for analyses, 139 (23.7%) developed PICHE (mean follow-up 1795 ± 1378 days). The median time of epilepsy onset was 7 months after ICH (range 1–132 months). Risk factors associated with PICHE were cortical hemorrhage (multivariable HR 1.65 [95% CI 1.14–2.37]; p = 0.008), ICH volume > 10 ml (multivariable HR 1.91 [95% CI 1.33–2.73]; p < 0.001) and acute symptomatic seizures (multivariable HR 1.81 [95% CI 1.20–2.75]; p = 0.005). Patients with cortical ICH > 10 ml who underwent surgical hematoma evacuation were less likely to develop epilepsy than those with conservative treatment alone (multivariable HR 0.26 [95% CI 0.08–0.84]; p = 0.025). Conclusions: Post-ICH epilepsy is frequent and predicted by large cortical ICH and acute symptomatic seizures. Hematoma evacuation reduced the risk of PICHE by more than 70% in patients with large cortical ICH. This finding could be considered in the clinical decision making on the acute treatment of ICH.
CRIS-Team Scopus Importer:2022-10-21
Keywords: CAVE score; hematoma evacuation; intracerebral hemorrhage; post-stroke epilepsy

Surgical planning, histopathology findings and postoperative outcome in MR-negative extra-temporal epilepsy using intracranial EEG, functional imaging, magnetoencephalography, neuronavigation and intraoperative MRI. - Maslarova, Anna; Zhao, Yining; Rösch, Julie; Dörfler, Arnd; Coras, Roland; Blümcke, Ingmar; Lang, Johannes; Schmidt, Manuel; Hamer, Hajo; Reindl, Caroline; Welte, Tamara; Rampp, Stefan; et al. (Clinical Neurology and Neurosurgery, 2023)
OBJECTIVE: MRI-negative drug-resistant epilepsy presents a challenge when it comes to surgical planning, and surgical outcome is worse than in cases with an identified lesion. Although increasing implementation of more powerful MRI scanners and artificial intelligence has led to the detection of previously unrecognizable lesions, in some cases even postoperative pathological evaluation of electrographically epileptogenic zones shows no structural alterations. While in temporal lobe epilepsy a standardized resection approach can usually be performed, the surgical management of extra-temporal lesions is always individual. Here we present a strategy for treating patients with extra-temporal MRI-negative epilepsy focus and report our histological findings and patient outcome. METHODS: Patients undergoing epilepsy surgery in the Department of Neurosurgery at the University Hospital Erlangen between 2012 and 2020 were included in the study. Inclusion criteria were: (1) failure to identify a structural lesion on preoperative high-resolution 3 Tesla MRI with a standardized epilepsy protocol and (2) preoperative intracranial EEG (iEEG) diagnostics. RESULTS: We identified 8 patients corresponding to the inclusion criteria. Second look MRI analysis by an experienced neuroradiologist including the most recent analysis algorithm utilized in our clinic revealed a possible lesion in two patients. One of the patients with a clear focal cortical dysplasia (FCD) finding on a second look was excluded from further analysis. Of the other 7 patients, in one patient iEEG was performed with subdural electrodes, whereas the other 6 were evaluated with depth electrodes. MEG was performed preoperatively in all but one patient. An MEG focus was implemented in resection planning in 3 patients. FDG PET was performed in all, but only implemented in one patient. Histopathological evaluation revealed one non-lesional case, 4 cases of FCD and 2 cases with mild developmental malformation. All patients were free from permanent neurological deficits and presented with Engel 1A or 1B outcome on the last follow-up. CONCLUSION: We demonstrate that extra-temporal MRI-negative epilepsy can be treated successfully provided an extensive preoperative planning is performed. The most important diagnostic was stereo-EEG, whereas additional data from MEG was helpful and FDG PET was rarely useful in our cohort.
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Susceptibility artifacts detected on 3T MRI of the knee: frequency, change over time and associations with radiographic findings: data from the Joints on Glucosamine Study - Jarraya, M.; Hayashi, D.; Guermazi, A.; Kwoh, C. K.; Hannon, M. J.; Moore, C. E.; Jakicic, J. M.; Green, S. M.; Roemer, Frank (Osteoarthritis and Cartilage, 2014)
To determine the prevalence of intraarticular susceptibility artifacts and to detect longitudinal changes in the artifacts, on 3T magnetic resonance imaging (MRI) of the knee in a cohort of patients with knee pain, and to assess the association of susceptibility artifacts with radiographic intraarticular calcifications.Three hundred and forty-six knees of 177 subjects aged 35-65 were included. 3T MRI was performed at baseline and at 6 months. Baseline radiographs were assessed for presence/absence of linear/punctate calcifications within the tibiofemoral joint (TFJ) space. Corresponding MRIs were assessed for susceptibility artifacts (i.e., linear/punctate hypointensities) in the TFJ space on coronal dual-echo steady-state (DESS) sequences. Kappa statistics were applied to determine agreement between findings on baseline DESS and radiography. Changes in artifacts over time were recorded.In the medial compartment, 13 (4%) of the knees showed susceptibility artifacts at baseline. Six knees had persistent artifacts and six knees had incident artifacts at follow-up. Agreement between DESS and radiography was ? = 0.18 (-0.15, 0.51) in the medial compartment. Frequency of artifacts in the lateral compartment was low (2%).Susceptibility artifacts detected on knee MRI are not frequent, and likely correspond to vacuum phenomena as they commonly change over time and are not associated with intraarticular calcifications. Radiologists should be aware of these artifacts as they can interfere with cartilage segmentation.
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Symmetric tract-based spatial statistics of patients with left versus right mesial temporal lobe epilepsy with hippocampal sclerosis - Mennecke, Angelika; Rösch, Julie; Kasper, Burkhard; Schmidt, Manuel; Roessler, Karl; Coras, Roland; Hamer, Hajo; Dörfler, Arnd; Laun, Frederik Bernd (NeuroReport, 2018)
This study aims to investigate the diffusion metrics of left versus right temporal lobe epilepsy in a well-defined subgroup of patients with mesial temporal lobe epilepsy (mTLE) because of unilateral hippocampal sclerosis while taking into account interhemispheric differences. Eighteen patients with TLE [nine left temporal lobe epilepsy (LTLE) and nine right temporal lobe epilepsy (RTLE)] and a norm group of 36 nonepileptic individuals were scanned with a multiband accelerated diffusion tensor imaging protocol at 3T. The scalar diffusion tensor parameters fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) and, after projection on a symmetric skeleton, their hemispheric difference (dFA, dMD, and dRD) were analyzed using tract-based spatial statistics. In the cluster with significantly (P<0.008) different dFA, dMD, and dRD between right TLE and left TLE, the hemispheric difference in the mean scalar indices (dmFA, dmMD, and dmRD) was assessed and tested for differences using a one-way analysis of variance and for correlation with patient age, seizure onset, or duration of epilepsy using Pearson's correlation. Patients with LTLE showed lower dFA, higher dMD, and higher dRD (P<0.008) compared with patients with RTLE in a cluster including parts of the uncinated and inferior longitudinal fasciculus and the inferior fronto-occipital fasciculus. dmFA, dmMD, and dmRD differed significantly between groups (P<10, corrected) and showed no correlation with patient age, seizure onset, or duration of epilepsy. The exclusion of bilateral interindividual variance through the calculation of the hemispheric difference of the diffusion metrics by the symmetric variant of tract-based spatial statistics allows for a sensitive differentiation of LTLE and RTLE with unilateral hippocampal sclerosis.
EVALuna2:34910

Synovitis in knee osteoarthritis: a precursor of disease? - Atukorala, I.; Kwoh, C. K.; Guermazi, A.; Roemer, Frank; Boudreau, R. M.; Hannon, M. J.; Hunter, D. J. (Annals of the Rheumatic Diseases, 2016)
It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee osteoarthritis (ROA).The participants in this nested case-control study were selected from persons in the Osteoarthritis Initiative with knees that had a Kellgren Lawrence grading (KLG)=0 at baseline (BL). These knees were evaluated annually with radiography and non-contrast-enhanced MRI over 4 years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by ROA (KLG>=2) on the postero-anterior knee radiographs at any assessment after BL. Radiographs were assessed at P0 (time of onset of ROA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from BL to 48 months).133 knees of 120 persons with ROA (83 women) were matched to 133 control knees (83 women). ORs for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and P0 were 1.56 (95% CI 0.86 to 2.81), 3.23 (1.72 to 6.06) and 4.7 (1.10 to 2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1 to 2.95), 2.47 (1.45 to 4.23) and 2.40 (1.43 to 4.04), respectively.Effusion-synovitis and Hoffa-synovitis strongly predicted the development of iROA.
EVALuna2:14484

Synovitis in knee osteoarthritis assessed by contrast-enhanced magnetic resonance imaging (MRI) is associated with radiographic tibiofemoral osteoarthritis and MRI-detected widespread cartilage damage: the MOST study - Guermazi, Ali; Hayashi, Daichi; Roemer, Frank; Zhu, Yanyan; Niu, Jingbo; Crema, Michel D.; Javaid, M. Kassim; Marra, Monica D.; Lynch, John A.; El-Khoury, George Y.; Zhang, Yuqing; Nevitt, Michael C.; et al. (Journal of Rheumatology, 2014)
To examine the cross-sectional association of whole-knee synovitis assessed by contrast-enhanced magnetic resonance imaging (CEMRI) with radiographic tibiofemoral osteoarthritis (OA), non-CEMRI-assessed cartilage damage, and meniscal status.Multicenter Osteoarthritis Study (MOST) is a cohort study of people with or at high risk of knee OA. Subjects are a subset of MOST who volunteered for both CEMRI and non-CEMRI. Using CEMRI, synovitis was assessed at 11 sites and graded 0-2 at each site. Presence of "whole-knee synovitis" was defined as the synovitis score of >= 1 at any site from each knee. Cartilage and meniscal damage was evaluated using non-CEMRI based on the Whole Organ MRI Score. Logistic regression was used to assess associations of synovitis with radiographic OA (Kellgren-Lawrence grade >= 2), widespread cartilage damage, and meniscal damage, adjusting for age, sex, and body mass index (BMI). Additional analyses were performed excluding subjects who had chondrocalcinosis on radiography and those taking antiinflammatory medications.Four hundred four subjects were included (mean age 58.8 ± 7.0 yrs, BMI 29.6 ± 4.9 kg/m(2), 45.5% women). On CEMRI, the maximum synovitis score across 11 sites in each knee was 0 in 106 knees (26.2%), 1 in 135 (33.4%), and 2 in 163 (40.4%). Synovitis was associated with radiographic OA [adjusted OR (aOR) 3.25, 95% CI 1.98-5.35] and widespread cartilage damage (aOR 1.91, 95% CI 1.24-2.92). Severe meniscal damage showed a borderline significant association with synovitis (aOR 1.74, 95% CI 0.99-3.04). Additional analyses as described did not notably change the results.CEMRI-detected synovitis is strongly associated with tibiofemoral radiographic OA and MRI-detected widespread cartilage damage.
EVALuna2:14548

?-Synuclein-induced myelination deficit defines a novel interventional target for multiple system atrophy - Ettle, Benjamin; Kerman, Bilal E.; Valera, Elvira; Gillmann, Clarissa; Schlachetzki, Johannes; Reiprich, Simone; Büttner, Christian; Ekici, Arif Bülent; Reis, André; Wegner, Michael; Bäuerle, Tobias; Riemenschneider, Markus J.; et al. (Acta Neuropathologica, 2016)
Multiple system atrophy (MSA) is a rare atypical parkinsonian disorder characterized by a rapidly progressing clinical course and at present without any efficient therapy. Neuropathologically, myelin loss and neurodegeneration are associated with ?-synuclein accumulation in oligodendrocytes, but underlying pathomechanisms are poorly understood. Here, we analyzed the impact of oligodendrocytic ?-synuclein on the formation of myelin sheaths to define a potential interventional target for MSA. Post-mortem analyses of MSA patients and controls were performed to quantify myelin and oligodendrocyte numbers. As pre-clinical models, we used transgenic MSA mice, a myelinating stem cell-derived oligodendrocyte-neuron co-culture, and primary oligodendrocytes to determine functional consequences of oligodendrocytic ?-synuclein overexpression on myelination. We detected myelin loss accompanied by preserved or even increased numbers of oligodendrocytes in post-mortem MSA brains or transgenic mouse forebrains, respectively, indicating an oligodendrocytic dysfunction in myelin formation. Corroborating this observation, overexpression of ?-synuclein in primary and stem cell-derived oligodendrocytes severely impaired myelin formation, defining a novel ?-synuclein-linked pathomechanism in MSA. We used the pro-myelinating activity of the muscarinic acetylcholine receptor antagonist benztropine to analyze the reversibility of the myelination deficit. Transcriptome profiling of primary pre-myelinating oligodendrocytes demonstrated that benztropine readjusts myelination-related processes such as cholesterol and membrane biogenesis, being compromised by oligodendrocytic ?-synuclein. Additionally, benztropine restored the ?-synuclein-induced myelination deficit of stem cell-derived oligodendrocytes. Strikingly, benztropine also ameliorated the myelin deficit in transgenic MSA mice, resulting in a prevention of neuronal cell loss. In conclusion, this study defines the ?-synuclein-induced myelination deficit as a novel and crucial pathomechanism in MSA. Importantly, the reversible nature of this oligodendrocytic dysfunction opens a novel avenue for an intervention in MSA.
EVALuna2:4991

Systematics of glenohumoral and acromioclavicular arthritis - Seifarth, A.; Roemer, Frank (Radiologe, 2015)
A common risk factor for osteoarthritis (OA) of the glenohumeral joint is instability and is often observed as a sequel to dislocation. Altered biomechanics will ultimately result in joint degeneration including osteophyte development at the lower margin of the humerus, glenoidal cartilage loss and surface deformity. An OA of the glenohumeral joint is often coexistent with soft tissue derangement of the shoulder. In advanced stages defects of the rotator cuff and OA of the glenohumeral joint may accelerate disease progression. Degenerative changes of the acromioclavicular joint (AC joint) are commonly seen in older persons with only modest correlation with clinical symptoms. Symptomatic OA of the AC joint is often concomitantly observed with degenerative changes of the glenohumeral joint.Standard radiographs are the basis of a structural assessment of shoulder OA but lack correlation with clinical symptoms and are insensitive for the detection of early degenerative changes. Magnetic resonance imaging (MRI) provides increased sensitivity for the detection of cartilage defects and reveals relevant soft tissue changes, such as lesions of the glenoid labrum and capsuloligamentous structures, which are seen in conjunction with instability. It is also the method of choice to detect clinically relevant bone marrow edema-like lesions or synovial changes that are associated with symptomatic OA.Standard radiographs are not applicable for detection of early degenerative changes. Once OA is suspected clinically, MRI is the method of choice for further structural assessment. The administration of an intravenous contrast agent is useful for assessing synovitis, which commonly correlates with clinical disease manifestations. For preoperative and surgical planning of joint replacement, MRI or CT should be used.
EVALuna2:14547

Systemic inflammatory response syndrome and long-term outcome after intracerebral hemorrhage - Hagen, Manuel; Sembill, Jochen; Sprügel, Maximilian; Gerner, Stefan; Madžar, Dominik; Lücking, Hannes; Hölter, Philip; Schwab, Stefan; Huttner, Hagen; Kuramatsu, Joji (Neurology, Neuroimmunology and Neuroinflammation, 2019)
ObjectiveTo investigate whether the systemic inflammatory response syndrome (SIRS) without infection as surrogate of a systemic immune response is associated with poor long-term functional outcome in patients with spontaneous intracerebral hemorrhage (ICH).MethodsWe analyzed consecutive patients with spontaneous ICH from our prospective cohort study (2018-2015). SIRS was defined according to standard criteria: i.e., 2 or more of the following parameters during hospitalization: body temperature <36°C or >38°C, respiratory rate >20 per minute, heart rate >90 per minute, or white blood cell count <4,000/L or >12,000/L in the absence of infection. The primary outcome consisted of the modified Rankin Scale (mRS) at 3 and 12 months investigated by adjusted ordinal shift analyses. Bias and confounding were addressed by propensity score matching and multivariable regression models.ResultsOf 780 patients with ICH, 21.8% (n = 170) developed SIRS during hospitalization. Patients with SIRS showed more severe ICH compared with those without; i.e., larger ICH volumes (18.3 cm3, interquartile range [IQR 4.6-47.2 cm3] vs 7.4 cm3, IQR [2.4-18.6 cm3]; p < 0.01), increased intraventricular hemorrhage (57.6%, n = 98/170 vs 24.8%, n = 79/319; p < 0.01), and poorer neurologic admission status (NIH Stroke Scale score 16, IQR [7-30] vs 6, IQR [3-12]; p < 0.01). ICH severity-adjusted analyses revealed an independent association of SIRS with poorer functional outcome after 3 (OR 1.80, 95% CI [1.08-3.00]; p = 0.025) and 12 months (OR 1.76, 95% CI [1.04-2.96]; p = 0.034). Increased ICH volumes on follow-up imaging (OR 1.38, 95% CI [1.01-1.89]; p = 0.05) and previous liver dysfunction (OR 3.01, 95% CI [1.03-10.19]; p = 0.04) were associated with SIRS.ConclusionsIn patients with ICH, we identified SIRS to be predictive of poorer long-term functional outcome over the entire range of mRS estimates. Clinically relevant associations with SIRS were documented for previous liver dysfunction and hematoma enlargement.
CRIS-Team Scopus Importer:2019-10-29

Systemic PPAR gamma Antagonism Reduces Metastatic Tumor Progression in Adipocyte-Rich Bone in Excess Weight Male Rodents - Gaculenko, Anastasia; Gregoric, Gasper; Popp, Vanessa; Seyler, Lisa; Ringer, Mark; Kachler, Katerina; Wu, Zhengquan; Kisel, Wadim; Hofbauer, Christine; Hofbauer, Lorenz C.; Uder, Michael; Schett, Georg; et al. (Journal of Bone and Mineral Research, 2021)
Primary tumors are widely associated with an excess in body fat. The role of adipose tissue on tumor cell homing to bone is yet poorly defined. In this study, we aimed to assess whether bone colonization by tumor cells is favored by an adipocyte-rich bone marrow. We delineated the accompanying alterations of the bone microenvironment and established a treatment approach that interferes with high fat diet (HFD)-induced bone metastasis formation. We were able to show that adipocytes affect skeletal tumor growth in a metastatic model of breast cancer in male rats and melanoma in male mice as well as in human breast cancer bone biopsies. Indeed, HFD-induced bone marrow adiposity was accompanied by accelerated tumor progression and increased osteolytic lesions. In human bone metastases, bone marrow adiposity correlated with tumor cell proliferation. By antagonization of the adipocyte differentiation and storage pathway linked to the peroxisome proliferator-activated receptor gamma (PPAR gamma) with bisphenol-A-diglycidylether (BADGE), we were able to decelerate tumor progression and subsequent osteolytic damage in the bones of two distinct metastatic animal models exposed to HFD. Overall these data show that adipose tissue is a critical factor in bone metastases and cancer-induced bone loss. 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
CRIS-Team WoS Importer:2021-09-03

T-2* Accelerated quantification of tissue sodium concentration in skeletal muscle tissue: quantitative capability of dictionary learning compressed sensing - Utzschneider, Matthias; Behl, Nicolas G. R.; Lachner, Sebastian; Gast, Lena; Maier, Andreas; Uder, Michael; Nagel, Armin Michael (Magnetic Resonance Materials in Physics Biology and Medicine, 2020)
OBJECTIVE: To accelerate tissue sodium concentration (TSC) quantification of skeletal muscle using 23Na MRI and 3D dictionary-learning compressed sensing (3D-DLCS). MATERIALS AND METHODS: Simulations and in vivo 23Na MRI examinations of calf muscle were performed with a nominal spatial resolution of [Formula: see text]. Fully sampled and three undersampled 23Na MRI data sets (undersampling factors (USF) = 3, 4.4, 6.7) were evaluated. Ten healthy subjects were examined on a 3 Tesla MRI system. Results of the simulation study and the in vivo measurements were compared to the ground truth (GT) and the fully sampled fast Fourier transform (NUFFT) reconstruction, respectively. RESULTS: Reconstruction results of simulated data with optimized 3D-DLCS yielded a lower deviation (< 4%) from the GT than results of the NUFFT reconstruction (> 5%) and a lower standard deviation (SD). For in vivo measurements, a TSC of [Formula: see text] was observed. The mean deviation from the reference is lower for the undersampled 3D-DLCS reconstructions (3.4%) than for NUFFT reconstructions (4.6%). SD is reduced using 3D-DLCS. Compared to a fully sampled NUFFT reconstruction, acquisition time could be reduced by a factor of 4.4 while maintaining similar quantitative accuracy. DISCUSSION: The optimized 3D-DLCS reconstruction enables accelerated TSC measurements with high quantification accuracy.
CRIS-Team WoS Importer:2020-01-31

T2 Mapping as a New Method for Quantitative Assessment of Cartilage Damage in RA - Renner, Nina; Kleyer, Arnd; Krönke, Gerhard; Simon, David; Söllner, Stefan; Rech, Jürgen; Uder, Michael; Janka, Rolf Matthias; Schett, Georg; Welsch, Goetz; Pachowsky, Milena (Journal of Rheumatology, 2019)
OBJECTIVE: Rheumatoid arthritis (RA) is associated with damage of the articular cartilage and the periarticular bone. While imaging of bone damage has substantially improved in the last years, direct imaging of the articular cartilage of the hand joints in patients with RA is still challenging. METHODS: 3 Tesla Magnetic Resonance Imaging (MRI) was done in 30 RA patients and T2 relaxation times visualizing alteration in the collagen network and hydration of articular cartilage were mapped in six cartilage regions of the metacarpophalangeal joints 2 and 3. Values were related to autoantibody (anti-citrullinated peptide antibodies (ACPA), rheumatoid factor (RF)) status, disease duration, disease activity as well as sex and age of the RA patients. RESULTS: T2 relaxation times could be reliably measured in the six regions of the metacarpophalangeal joints. Significantly higher relaxation times indicating more advanced cartilage alterations were observed in ACPA-positive (p=0.001-0.010) and RF-positive patients (p=0.013-0.025) as well as those with longer disease duration (>3 years; p=0.028-0.043). Current disease activity, sex and age did not influence T2 relaxation times. CONCLUSION: These data show that cartilage damage can be localized and quantified in the hand joints of RA patients by T2 mapping. Furthermore, ACPA and RF positivity as well as disease duration appear to be the crucial factors influencing cartilage damage.
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T2-sequence with contrast inversion: diagnostic value in the investigation of gray matter heterotopias - Rösch, Julie; Mennecke, Angelika; Knott, Michael; Hamer, Hajo; Dörfler, Arnd; Engelhorn, Tobias Martin (NeuroReport, 2020)
To compare the diagnostic value of T1-inversion recovery sequence (T1 IR) to that of a T2-sequence with contrast inversion (T2 CI) in the investigation of heterotopias. In this study, we processed a contrast-inverted copy of our coronal T2-sequence of 21 patients with subependymal and subcortical heterotopias on an online picture archiving and communication system workstation. The diagnostic performance of these images was compared with the T1 IR of the same patients by quantitative and qualitative assessments regarding signal-to-noise ratio (SNR), lesion-to-white matter contrast-to-noise ratio (CNR), lesion conspicuity, level of artifacts, overall image quality as well as diagnostic content. SNR values of the T2 CI were significantly higher than those of the T1 IR. CNR values of both sequences were similar. No relevant difference was found for lesion conspicuity and level of artifacts. Overall image quality of the T2 CI was rated slightly better by one reader. Both readers voted the images to have the same diagnostic content. Beside the exact depiction of the hippocampus in the high resoluted T2-sequence, its contrast-inverted copy (T2 CI) is also useful in the detection of heterotopias. In conjunction with the MPRAGE or MP2RAGE as a three-dimensional sequence, it could offer an equivalent and time-saving alternative to the T1 IR in the investigation of this type of malformation of cortical development.
CRIS-Team Scopus Importer:2020-05-29

Tanezumab for chronic low back pain: a randomized, double-blind, placebo- and active-controlled, phase 3 study of efficacy and safety - Markman, John D.; Bolash, Robert B.; Mcalindon, Timothy E.; Kivitz, Alan J.; Pombo-Suarez, Manuel; Ohtori, Seiji; Roemer, Frank; Li, David J.; Viktrup, Lars; Bramson, Candace; West, Christine R.; Verburg, Kenneth M. (Pain, 2020)
This randomized, double-blind, phase 3 study (56-week treatment; 24-week follow-up) assessed tanezumab in patients with chronic low back pain and history of inadequate response to standard-of-care analgesics (NCT02528253). Patients received placebo, subcutaneous tanezumab (5 or 10 mg every 8 weeks), or oral tramadol prolonged-release (100-300 mg/day). Primary endpoint was change in low back pain intensity (LBPI) at week 16 for tanezumab vs placebo. Key secondary endpoints were proportion of patients with >= 50% decrease in LBPI at week 16, change in Roland Morris Disability Questionnaire at week 16, and change in LBPI at week 2 for tanezumab vs placebo. Adverse events and joint safety were assessed through weeks 56 and 80, respectively. Tanezumab 10 mg met the primary endpoint by significantly improving LBPI at week 16 vs placebo; least squares (LS) mean (95% CI) difference = -0.40 (-0.76 to -0.04;P= 0.0281). Tanezumab 10 mg significantly improved all key secondary endpoints. Tanezumab 5 mg did not meet the primary endpoint (LS mean [95% CI] treatment difference vs placebo = -0.30 [-0.66 to 0.07;P= 0.1117]), preventing formal testing of key secondary endpoints for this dose. The proportion of patients with >= 50% improvement in LBPI at week 16 was 37.4% in the placebo group, 43.3% in the tanezumab 5 mg group (Odds ratio [95% CI] vs placebo = 1.28 [0.97 to 1.70;P= 0.0846]), and 46.3% in the tanezumab 10 mg group (Odds ratio [95% CI] vs placebo = 1.45 [1.09 to 1.91;P= 0.0101]). Prespecified joint safety events were more frequent with tanezumab 10 mg (2.6%) than tanezumab 5 mg (1.0%), tramadol (0.2%), or placebo (0%). Seven patients, all in the tanezumab 10 mg group (1.4%), underwent total joint replacement. In conclusion, tanezumab 10 mg significantly improved pain and function vs placebo in patients with difficult-to-treat chronic low back pain. Tanezumab was associated with a low rate of joint safety events, some requiring joint replacement.
CRIS-Team WoS Importer:2020-10-09

Targeting Muscular Hemoglobin Content for Classification of Peripheral Arterial Disease by Noninvasive Multispectral Optoacoustic Tomography - Günther, Josefine; Knieling, Ferdinand; Träger, Anna P.; Lang, Werner; Meyer, Alexander; Regensburger, Adrian; Wagner, Alexandra; Trollmann, Regina; Wölfle, Joachim; Klett, Daniel; Uter, Wolfgang; Uder, Michael; et al. (Journal of the American College of Cardiology : Cardiovascular imaging, 2023)
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Teaching NeuroImages: Stroke and bilateral visual loss in a young adult: More than coincidence - Volbers, Bastian; Kaldefoss, K.; Bergua, A.; Kloska, Stephan; Schwab, Sibylle; Köhrmann, Martin (Neurology, 2012)
EVALuna2:21072

Technical feasibility of 2D-3D coregistration for visualization of self-expandable microstents to facilitate coil embolization of broad-based intracranial aneurysms: An in vitro study - Richter, Gregor; Pfister, Marcus; Struffert, Tobias; Engelhorn, Tobias; Dölken, Marc; Spiegel, Martin; Hornegger, Joachim; Dörfler, Arnd (Neuroradiology, 2009)
Introduction: The use of self-expandable microstents for treatment of broad-based intracranial aneurysms is widely spread. However, poor fluoroscopic visibility of the stents remains disadvantageous during the coiling procedure. Flat detector angiographic computed tomography (ACT) provides high resolution imaging of microstents even though integration of this imaging modality in the neurointerventional workflow has not been widely reported. Methods: An acrylic glass model was used to simulate the situation of a broad-based sidewall aneurysm. After insertion of a self-expandable microstent, ACT was performed. The resulting 3D dataset of the Microstent was subsequently projected into a conventional 2D fluoroscopic roadmap. This 3D visualization of the stent supported the coil embolization procedure of the in vitro aneurysm. Results: In vitro 2D-3D coregistration with integration of 3D ACT data of a self-expandable microstent in a conventional 2D roadmap is feasible. Conclusions: Unsatisfying stent visibility constrains clinical cases with complex parent vessel anatomy and challenging aneurysm geometry; hence, this technique potentially may be useful in such cases. In our opinion, the clinical feasibility and utility of this new technique should be verified in a clinical aneurysm embolization study series using 2D-3D coregistration. © 2009 Springer-Verlag.

Technical Note: On the size of susceptibility-induced MR image distortions in prostate and cervix in the context of MR-guided radiation therapy - Emmerich, Julian; Pfaffenberger, Asja; Schilling, Rebecca; Denoix, Michael; Maier, Florian; Sterzing, Florian; Bostel, Tilman; Straub, Sina; Laun, Frederik Bernd (Medical Physics, 2018)
PURPOSE: To investigate the extent of MR image distortions in the pelvis caused by susceptibility-induced field inhomogeneities in MR images in the context of a study on MR-guided radiotherapy. METHODS: Using a high-bandwidth double-echo gradient echo sequence, field maps and distortion maps of the pelvis were calculated and evaluated for 219 exams (92 of female and 127 of male patients) to investigate patient-related image distortions caused by susceptibility differences in an ongoing study on MR-guided radiotherapy. The evaluation of distortions in the regions "rectum", "prostate", "cervix", and in a reference region in the gluteus maximus was based on masks drawn by two readers. RESULTS: Distortions in the prostate and cervix were smaller than 0.03 px (0.1 mm) for 99% of voxels, and reached a maximum value of 0.09 px (0.3 mm). In the reference region, maximum distortions were smaller than in the prostate and cervix. CONCLUSIONS: Using a geometric uncertainty of 0.2 px (0.6 mm) in margin definition for organs that are close to the rectum like the prostate and the cervix would be a cautious choice to account for susceptibility-induced distortions that can arise during MR-based treatment guidance for the imaging setting used in this study. Since distortions are inversely proportional to the readout bandwidth of the sequence, safety margins need to be adapted adequately. Additional sources of image distortions like gradient nonlinearities are not included in our margin recommendations and should be considered separately.
EVALuna2:36257

Temperature and concentration calibration of aqueous polyvinylpyrrolidone (PVP) solutions for isotropic diffusion MRI phantoms - Wagner, Friedrich; Kuder, Tristan A.; Mlynarska, Anna; Maier, Florian; Faust, Jonas; Demberg, Kerstin; Lindemann, Linus; Rivkin, Boris; Nagel, Armin Michael; Ladd, Mark E.; Maier-Hein, Klaus; Bickelhaupt, Sebastian; et al. (PLoS ONE, 2017)
To use the "apparent diffusion coefficient" (Dapp) as a quantitative imaging parameter, well-suited test fluids are essential. In this study, the previously proposed aqueous solutions of polyvinylpyrrolidone (PVP) were examined and temperature calibrations were obtained. For example, at a temperature of 20°C, Dapp ranged from 1.594 (95% CI: 1.593, 1.595) ?m2/ms to 0.3326 (95% CI: 0. 3304, 0.3348) ?m2/ms for PVP-concentrations ranging from 10% (w/w) to 50% (w/w) using K30 polymer lengths. The temperature dependence of Dapp was found to be so strong that a negligence seems not advisable. The temperature dependence is descriptively modelled by an exponential function exp(c2 (T - 20°C)) and the determined c2 values are reported, which can be used for temperature calibration. For example, we find the value 0.02952 K-1 for 30% (w/w) PVP-concentration and K30 polymer length. In general, aqueous PVP solutions were found to be suitable to produce easily applicable and reliable Dapp-phantoms.
EVALuna2:14661

Temporal and Volumetric Denoising via Quantile Sparse Image Prior - Schirrmacher, Franziska; Köhler, Thomas; Endres, Jürgen; Lindenberger, Tobias; Husvogt, Lennart; Fujimoto, James G.; Hornegger, Joachim; Dörfler, Arnd; Maier, Andreas; Hölter, Philip (Medical Image Analysis, 2018)
This paper introduces an universal and structure-preserving regularization term, called quantile sparse image (QuaSI) prior. The prior is suitable for denoising images from various medical imaging modalities. We demonstrate its effectiveness on volumetric optical coherence tomography (OCT) and computed tomography (CT) data, which show different noise and image characteristics. OCT offers high-resolution scans of the human retina but is inherently impaired by speckle noise. CT on the other hand has a lower resolution and shows high-frequency noise. For the purpose of denoising, we propose a variational framework based on the QuaSI prior and a Huber data fidelity model that can handle 3-D and 3-D+t data. Efficient optimization is facilitated through the use of an alternating direction method of multipliers (ADMM) scheme and the linearization of the quantile filter. Experiments on multiple datasets emphasize the excellent performance of the proposed method.<br
UnivIS-Import:2018-09-11:Pub.2018.tech.IMMD.IMMD5.tempor
Keywords: Spatio-temporal denoising; Variational approach; QuaSI prior; ADMM

Temporal lobe reactions after carbon ion radiation therapy: comparison of relative biological effectiveness-weighted tolerance doses predicted by local effect models I and IV - Gillmann, Clarissa; Jäkel, Oliver; Schlampp, Ingmar; Karger, Christian P. (International Journal of Radiation Oncology Biology Physics, 2014)
To compare the relative biological effectiveness (RBE)-weighted tolerance doses for temporal lobe reactions after carbon ion radiation therapy using 2 different versions of the local effect model (LEM I vs LEM IV) for the same patient collective under identical conditions.In a previous study, 59 patients were investigated, of whom 10 experienced temporal lobe reactions (TLR) after carbon ion radiation therapy for low-grade skull-base chordoma and chondrosarcoma at Helmholtzzentrum für Schwerionenforschung (GSI) in Darmstadt, Germany in 2002 and 2003. TLR were detected as visible contrast enhancements on T1-weighted MRI images within a median follow-up time of 2.5 years. Although the derived RBE-weighted temporal lobe doses were based on the clinically applied LEM I, we have now recalculated the RBE-weighted dose distributions using LEM IV and derived dose-response curves with Dmax,V-1 cm³ (the RBE-weighted maximum dose in the remaining temporal lobe volume, excluding the volume of 1 cm³ with the highest dose) as an independent dosimetric variable. The resulting RBE-weighted tolerance doses were compared with those of the previous study to assess the clinical impact of LEM IV relative to LEM I.The dose-response curve of LEM IV is shifted toward higher values compared to that of LEM I. The RBE-weighted tolerance dose for a 5% complication probability (TD5) increases from 68.8 ± 3.3 to 78.3 ± 4.3 Gy (RBE) for LEM IV as compared to LEM I.LEM IV predicts a clinically significant increase of the RBE-weighted tolerance doses for the temporal lobe as compared to the currently applied LEM I. The limited available photon data do not allow a final conclusion as to whether RBE predictions of LEM I or LEM IV better fit better clinical experience in photon therapy. The decision about a future clinical application of LEM IV therefore requires additional analysis of temporal lobe reactions in a comparable photon-treated collective using the same dosimetric variable as in the present study.
EVALuna2:14518

Test–retest precision and longitudinal cartilage thickness loss in the IMI-APPROACH cohort - Wirth, W.; Maschek, S.; Marijnissen, A. C.A.; Lalande, A.; Blanco, F. J.; Berenbaum, F.; van de Stadt, L. A.; Kloppenburg, M.; Haugen, I. K.; Ladel, C. H.; Bacardit, J.; Wisser, A.; et al. (Osteoarthritis and Cartilage, 2022)
Objective: To investigate the test–retest precision and to report the longitudinal change in cartilage thickness, the percentage of knees with progression and the predictive value of the machine-learning-estimated structural progression score (s-score) for cartilage thickness loss in the IMI-APPROACH cohort – an exploratory, 5-center, 2-year prospective follow-up cohort. Design: Quantitative cartilage morphology at baseline and at least one follow-up visit was available for 270 of the 297 IMI-APPROACH participants (78% females, age: 66.4 ± 7.1 years, body mass index (BMI): 28.1 ± 5.3 kg/m2, 55% with radiographic knee osteoarthritis (OA)) from 1.5T or 3T MRI. Test–retest precision (root mean square coefficient of variation) was assessed from 34 participants. To define progressor knees, smallest detectable change (SDC) thresholds were computed from 11 participants with longitudinal test–retest scans. Binary logistic regression was used to evaluate the odds of progression in femorotibial cartilage thickness (threshold: −211 μm) for the quartile with the highest vs the quartile with the lowest s-scores. Results: The test–retest precision was 69 μm for the entire femorotibial joint. Over 24 months, mean cartilage thickness loss in the entire femorotibial joint reached −174 μm (95% CI: [−207, −141] μm, 32.7% with progression). The s-score was not associated with 24-month progression rates by MRI (OR: 1.30, 95% CI: [0.52, 3.28]). Conclusion: IMI-APPROACH successfully enrolled participants with substantial cartilage thickness loss, although the machine-learning-estimated s-score was not observed to be predictive of cartilage thickness loss. IMI-APPROACH data will be used in subsequent analyses to evaluate the impact of clinical, imaging, biomechanical and biochemical biomarkers on cartilage thickness loss and to refine the machine-learning-based s-score. Clinicaltrials.gov identification: NCT03883568.
CRIS-Team Scopus Importer:2022-12-02
Keywords: Cartilage loss; Knee; MRI; Osteoarthritis; Progression; Test–retest precision

Tetrahedral and polyhedral mesh evaluation for cerebral hemodynamic simulation–a comparison - Spiegel, Martin; Redel, Thomas; Zhang, Yao; Struffert, Tobias; Hornegger, Joachim; Grossman, Robert G.; Dörfler, Arnd; Karmonik, Christof (Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, 2009)
Computational fluid dynamic (CFD) based on patient-specific medical imaging data has found widespread use for visualizing and quantifying hemodynamics in cerebrovascular disease such as cerebral aneurysms or stenotic vessels. This paper focuses on optimizing mesh parameters for CFD simulation of cerebral aneurysms. Valid blood flow simulations strongly depend on the mesh quality. Meshes with a coarse spatial resolution may lead to an inaccurate flow pattern. Meshes with a large number of elements will result in unnecessarily high computation time which is undesirable should CFD be used for planning in the interventional setting. Most CFD simulations reported for these vascular pathologies have used tetrahedral meshes. We illustrate the use of polyhedral volume elements in comparison to tetrahedral meshing on two different geometries, a sidewall aneurysm of the internal carotid artery and a basilar bifurcation aneurysm. The spatial mesh resolution ranges between 5,119 and 228,118 volume elements. The evaluation of the different meshes was based on the wall shear stress previously identified as a one possible parameter for assessing aneurysm growth. Polyhedral meshes showed better accuracy, lower memory demand, shorter computational speed and faster convergence behavior (on average 369 iterations less).
UnivIS-Import:2017-01-09:Pub.2009.tech.IMMD.IMMD5.tetrah_3

Tetrahedral vs. polyhedral mesh size evaluation on flow velocity and wall shear stress for cerebral hemodynamic simulation - Spiegel, Martin; Redel, Thomas; Zhang, Y. Jonathan; Struffert, Tobias; Hornegger, Joachim; Grossman, Robert G.; Dörfler, Arnd; Karmonik, Christof (Computer Methods in Biomechanics and Biomedical Engineering, 2011)
Haemodynamic factors, in particular wall shear stresses (WSSs) may have significant impact on growth and rupture of cerebral aneurysms. Without a means to measure WSS reliably in vivo, computational fluid dynamic (CFD) simulations are frequently employed to visualise and quantify blood flow from patient-specific computational models. With increasing interest in integrating these CFD simulations into pretreatment planning, a better understanding of the validity of the calculations in respect to computation parameters such as volume element type, mesh size and mesh composition is needed. In this study, CFD results for the two most common aneurysm types (saccular and terminal) are compared for polyhedral- vs. tetrahedral-based meshes and discussed regarding future clinical applications. For this purpose, a set of models were constructed for each aneurysm with spatially varying surface and volume mesh configurations (mesh size range: 5119-258, 481 volume elements). WSS distribution on the model wall and point-based velocity measurements were compared for each configuration model. Our results indicate a benefit of polyhedral meshes in respect to convergence speed and more homogeneous WSS patterns. Computational variations of WSS values and blood velocities are between 0.84 and 6.3% from the most simple mesh (tetrahedral elements only) and the most advanced mesh design investigated (polyhedral mesh with boundary layer). © 2011 Taylor & Francis.

The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke - Fröhlich, Kilian; Siedler, Gabriela; Stoll, Svenja; Macha, Kosmas; Kinfe, Thomas Mehari; Dörfler, Arnd; Eisenhut, Felix; Engelhorn, Tobias; Hölter, Philip; Lang, Stefan; Mühlen, Iris; Schmidt, Manuel; et al. (Neuroradiology, 2021)
Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician's decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician's decision on using GA in EVT.
CRIS-Team WoS Importer:2021-07-23

The annual meeting of the German society of neuroradiology cologne, October 10th to 12th, 2013 - Dörfler, Arnd (Clinical Neuroradiology, 2013)
CRIS-Team Scopus Importer:2022-08-05

The AP-1 Transcription Factor c-Jun Promotes Arthritis by Regulating Cyclooxygenase-2 and Arginase-1 Expression in Macrophages - Hannemann, Nicole; Jordan, Jutta; Paul, Sushmita; Reid, Stephen; Baenkler, Hanns-Wolf; Sonnewald, Sophia; Bäuerle, Tobias; Vera, Julio; Schett, Georg; Bozec, Aline (Journal of Immunology, 2017)
Activation of proinflammatory macrophages is associated with the inflammatory state of rheumatoid arthritis. Their polarization and activation are controlled by transcription factors such as NF-?B and the AP-1 transcription factor member c-Fos. Surprisingly, little is known about the role of the AP-1 transcription factor c-Jun in macrophage activation. In this study, we show that mRNA and protein levels of c-Jun are increased in macrophages following pro- or anti-inflammatory stimulations. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment cluster analyses of microarray data using wild-type and c-Jun-deleted macrophages highlight the central function of c-Jun in macrophages, in particular for immune responses, IL production, and hypoxia pathways. Mice deficient for c-Jun in macrophages show an amelioration of inflammation and bone destruction in the serum-induced arthritis model. In vivo and in vitro gene profiling, together with chromatin immunoprecipitation analysis of macrophages, revealed direct activation of the proinflammatory factor cyclooxygenase-2 and indirect inhibition of the anti-inflammatory factor arginase-1 by c-Jun. Thus, c-Jun regulates the activation state of macrophages and promotes arthritis via differentially regulating cyclooxygenase-2 and arginase-1 levels.
EVALuna2:13412

The association of frontal plane alignment to MRI-defined worsening of patellofemoral osteoarthritis: the MOST study - Macri, E. M.; Felson, D. T.; Ziegler, M. L.; Cooke, T. D. V.; Guermazi, A.; Roemer, Frank; Neogi, Tuhina; Torner, J.; Lewis, C. E.; Nevitt, M. C.; Stefanik, J. J. (Osteoarthritis and Cartilage, 2019)
Objective: To determine the sex-specific relation of frontal plane alignment (FPA) to magnetic resonance imaging (MRI)-defined features of patellofemoral osteoarthritis, and also to tibiofemoral osteoarthritis and knee pain.
CRIS-Team WoS Importer:2019-03-08

The cellular heat shock response monitored by chemical exchange saturation transfer MRI - Kleimaier, Dennis; Goerke, Steffen; Nies, Cordula; Zaiß, Moritz; Kunz, Patrick; Bachert, Peter; Ladd, Mark E.; Gottwald, Eric; Schad, Lothar R. (Scientific Reports, 2020)
CEST-MRI of the rNOE signal has been demonstrated in vitro to be closely linked to the protein conformational state. As the detectability of denaturation and aggregation processes on a physiologically relevant scale in living organisms has yet to be verified, the aim of this study was to perform heat-shock experiments with living cells to monitor the cellular heat-shock response of the rNOE CEST signal. Cancer cells (HepG2) were dynamically investigated after a mild, non-lethal heat-shock of 42 °C for 20 min using an MR-compatible bioreactor system at 9.4 T. Reliable and fast high-resolution CEST imaging was realized by a relaxation-compensated 2-point contrast metric. After the heat-shock, a substantial decrease of the rNOE CEST signal by 8.0 ± 0.4% followed by a steady signal recovery within a time of 99.1 ± 1.3 min was observed in two independent trials. This continuous signal recovery is in coherence with chaperone-induced refolding of heat-shock induced protein aggregates. We demonstrated that protein denaturation processes influence the CEST-MRI signal on a physiologically relevant scale. Thus, the protein folding state is, along with concentration changes, a relevant physiological parameter for the interpretation of CEST signal changes in diseases that are associated with pathological changes in protein expression, like cancer and neurodegenerative diseases.
CRIS-Team Scopus Importer:2020-07-17

The Chorioallantoic Membrane Xenograft Assay as a Reliable Model for Investigating the Biology of Breast Cancer - Ranjan, Raphela A.; Muenzner, Julienne K.; Kunze, Philipp; Geppert, Carol-Immanuel; Rübner, Matthias; Hübner, Hanna; Fasching, Peter; Beckmann, Matthias; Bäuerle, Tobias; Hartmann, Arndt; Walther, Wolfgang; Eckstein, Markus; et al. (Cancers, 2023)
The chorioallantoic membrane (CAM) assay is an alternative in vivo model that allows for minimally invasive research of cancer biology. Using the CAM assay, we investigated phenotypical and functional characteristics (tumor grade, mitosis rate, tumor budding, hormone receptor (HR) and HER2 status, Ki-67 proliferation index) of two breast cancer cell lines, MCF-7 and MDA-MB-231, which resemble the HR+ (luminal) and triple-negative breast cancer (TNBC) subgroups, respectively. Moreover, the CAM results were directly compared with murine MCF-7- and MDA-MB-231-derived xenografts and human patient TNBC tissue. Known phenotypical and biological features of the aggressive triple-negative breast cancer cell line (MDA-MB-231) were confirmed in the CAM assay, and mouse xenografts. Furthermore, the histomorphological and immunohistochemical variables assessed in the CAM model were similar to those in human patient tumor tissue. Given the confirmation of the classical biological and growth properties of breast cancer cell lines in the CAM model, we suggest this in vivo model to be a reliable alternative test system for breast cancer research to reduce murine animal experiments.
CRIS-Team Scopus Importer:2023-04-14
Keywords: 3R; alternative in vivo model; CAM model; hormone receptor; HTB-26; MCF-7; MDA-MB-231; mouse xenograft; tumor aggressiveness

The clinical data intelligence project - Sonntag, Daniel; Tresp, Volker; Zillner, Sonja; Hammon, Matthias; Reis, André; Fasching, Peter; Sedlmayr, Martin; Ganslandt, Thomas; Prokosch, Hans-Ulrich; Budde, Clemens; Schmidt, Danilo; Hinrichs, Carl; et al. (Informatik-Spektrum, 2015)
UnivIS-Import:2017-12-18:Pub.2015.tech.IMMD.infome.thecli

The complement system drives local inflammatory tissue priming by metabolic reprogramming of synovial fibroblasts - Friščić, Jasna; Böttcher, Martin; Reinwald, Christiane; Bruns, Heiko; Wirth, Benjamin; Popp, Sebastian; Walker, Kellie Irene; Ackermann, Jochen A.; Chen, Xi; Turner, Jason; Zhu, Honglin; Seyler, Lisa; et al. (Immunity, 2021)
Arthritis typically involves recurrence and progressive worsening at specific predilection sites, but the checkpoints between remission and persistence remain unknown. Here, we defined the molecular and cellular mechanisms of this inflammation-mediated tissue priming. Re-exposure to inflammatory stimuli caused aggravated arthritis in rodent models. Tissue priming developed locally and independently of adaptive immunity. Repeatedly stimulated primed synovial fibroblasts (SFs) exhibited enhanced metabolic activity inducing functional changes with intensified migration, invasiveness and osteoclastogenesis. Meanwhile, human SF from patients with established arthritis displayed a similar primed phenotype. Transcriptomic and epigenomic analyses as well as genetic and pharmacological targeting demonstrated that inflammatory tissue priming relies on intracellular complement C3- and C3a receptor-activation and downstream mammalian target of rapamycin- and hypoxia-inducible factor 1α-mediated metabolic SF invigoration that prevents activation-induced senescence, enhances NLRP3 inflammasome activity, and in consequence sensitizes tissue for inflammation. Our study suggests possibilities for therapeutic intervention abrogating tissue priming without immunosuppression.
CRIS-Team Scopus Importer:2021-04-19
Keywords: arthritis; cell metabolism; cellular senescence; complement system; inflammasome; inflammation; mechanistic target of rapamycin; synovial fibroblasts; tissue priming; trained immunity

The current status of imaging in anti-NGF clinical trials - Miller, C. G.; Guermazi, A.; Roemer, Frank (Osteoarthritis and Cartilage, 2015)
EVALuna2:14551

The diagnosis, treatment and follow-up of extracranial carotid stenosis: A multidisciplinary German-Austrian guideline based on evidence and consensus Diagnostik, Therapie und Nachsorge der extrakraniellen Carotisstenose: Multidisziplinäre, evidenz- und konsensbasierte deutsch-österreichische Leitlinie - Eckstein, Hans-Henning; Kuehnl, Andreas; Dörfler, Arnd; Kopp, Ina B.; Lawall, Holger; Ringleb, Peter A. (Deutsches Ärzteblatt international, 2013)
Background: Extracranial atherosclerotic lesions of the carotid bifurcation cause 10% to 20% of all cases of cerebral ischemia. Until now, there have been no comprehensive evidence- and consensus-based recommendations for the management of patients with extracranial carotid stenosis in Germany and Austria. Methods: The literature was systematically searched for pertinent publications (1990-2011). On the basis of 182 randomized clinical trials (RCTs) and 308 systematic reviews, 30 key questions were answered and evidence-based recommendations were issued.
CRIS-Team Scopus Importer:2022-08-05

The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study - Stefanik, Joshua J.; Neogi, Tuhina; Niu, Jingbo; Roemer, Frank; Segal, Neil A.; Lewis, Cora E.; Nevitt, Michael; Guermazi, Ali; Felson, David T. (Journal of Rheumatology, 2014)
To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage.The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain.There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested.Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.
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The Distribution of Pelvic Nodal Metastases in Prostate Cancer Reveals Potential to Advance and Personalize Pelvic Radiotherapy - Filimonova, Irina; Schmidt, Daniela; Mansoorian, Sina; Weissmann, Thomas; Siavooshhaghighi, Hadi; Kuwert, Torsten; Bert, Christoph; Frey, Benjamin; Distel, Luitpold; Lettmaier, Sebastian; Fietkau, Rainer; Putz, Florian; et al. (Frontiers in Oncology, 2021)
Background: Traditional clinical target volume (CTV) definition for pelvic radiotherapy in prostate cancer consists of large volumes being treated with homogeneous doses without fully utilizing information on the probability of microscopic involvement to guide target volume design and prescription dose distribution. Methods: We analyzed patterns of nodal involvement in 75 patients that received RT for pelvic and paraaortic lymph node metastases (LNs) from prostate cancer in regard to the new NRG-CTV recommendation. Non-rigid registration-based LN mapping and weighted three-dimensional kernel density estimation were used to visualize the average probability distribution for nodal metastases. As independent approach, the mean relative proportion of LNs observed for each level was determined manually and NRG and non-NRG levels were evaluated for frequency of involvement. Computer-automated distance measurements were used to compare LN distances in individual patients to the spatial proximity of nodal metastases at a cohort level. Results: 34.7% of patients had pelvic LNs outside NRG-consensus, of which perirectal was most common (25.3% of all patients) followed by left common iliac nodes near the left psoas major (6.7%). A substantial portion of patients (13.3%) had nodes at the posterior edge of the NRG obturator level. Observer-independent mapping consistently visualized high-probability hotspots outside NRG-consensus in the perirectal and left common iliac regions. Affected nodes in individual patients occurred in highly significantly closer proximity than at cohort-level (mean distance, 6.6 cm vs. 8.7 cm, p < 0.001). Conclusions: Based on this analysis, the common iliac level should extend to the left psoas major and obturator levels should extend posteriorly 5 mm beyond the obturator internus. Incomplete coverage by the NRG-consensus was mostly because of perirectal involvement. We introduce three-dimensional kernel density estimation after non-rigid registration-based mapping for the analysis of recurrence data in radiotherapy. This technique provides an estimate of the underlying probability distribution of nodal involvement and may help in addressing institution- or subgroup-specific differences. Nodal metastases in individual patients occurred in highly significantly closer proximity than at a cohort-level, which supports that personalized target volumes could be reduced in size compared to a “one-size-fits-all” approach and is an important basis for further investigation into individualized field designs.
CRIS-Team Scopus Importer:2021-02-05
Keywords: lymph node metastases; mapping; patterns of recurrence; pelvic radiotherapy; prostate cancer

The effect of ageing on fat infiltration of thigh and paraspinal muscles in men - Engelke, Klaus; Ghasemikaram, Mansour; Chaudry, Oliver; Uder, Michael; Nagel, Armin Michael; Jakob, Franz; Kemmler, Wolfgang (Aging Clinical and Experimental Research, 2022)
Background Myosteatosis, skeletal muscle fat infiltration, is associated with inflammation and fibrosis. The age-related increase of myosteatosis is an important characteristic of sarcopenia and contributes to fragility. Aims To investigate the impact of healthy aging on intermuscular adipose tissue (IMAT) and muscle fat fraction (FF) in the thigh and the paraspinal muscles in males. Methods In 54 healthy males (age 20-70), all active hobby golfers, magnetic resonance imaging was performed to determine volume of IMAT, volume of muscle tissue (MT) and of percentage of FF. Results Between ages 20-70, at the thigh, IMAT/MT volume and MT FF increased annually by 2.9% and 1.3%, respectively. At the psoas IMAT/Psoas volume did not change with age. MT FF increased by 1.5% annually. At the erector spinae IMAT/Erector volume decreased by 0.3% and MT FF increased by 2.8% annually. Discussion With increasing age, in males, thigh muscle atrophied, muscle tissue was partly replaced by adipose tissue and remaining muscle tissue also contained more fat. Similar effects were observed in the erector spinae. The psoas muscle did not atrophy, although MT FF also increased with age. Overall correlations with age were weak to moderate with higher correlations observed in the paraspinal muscles. Conclusions Age-related increases of muscle fat infiltration were observed in the thigh and in the spine. Muscle atrophy did not occur in the psoas. In cross-sectional studies, an adjustment of volumetric parameters by muscle volume is advisable when comparing age-dependent results.
CRIS-Team WoS Importer:2022-06-10
Keywords: MRI; Thigh; Erector spinae; Psoas; IMAT; Muscle fat fraction

The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis - Schinzel, Eileen; Kast, Stephanie; Kohl, Matthias; von Stengel, Simon; Jakob, Franz; Kerschan-Schindl, Katharina; Kladny, Bernd; Lange, Uwe; Peters, Stefan; Thomasius, Friederike; Clausen, Juergen; Uder, Michael; et al. (Frontiers in Physiology, 2023)
Introduction: Aquatic or water-based exercise is a very popular type of exercise in particular for people with physical limitations, joint problems and fear of falling. The present systematic review and meta-analysis aimed to provide evidence for the effect of aquatic exercise on Bone Mineral Density (BMD) in adults.Methods: A systematic literature search of five electronic databases (PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science and CINAHL) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted until 2022/01/30, with an update to 2022/10/07. We included controlled trials with a duration of more than 6 months and at least two study groups, aquatic exercise (EG) versus non-training controls (CG) with no language restrictions. Outcome measures were standardized mean differences (SMD) with 95%-confidence intervals (95%-CI) for BMD changes at the lumbar spine (LS) and femoral neck (FN). We applied a random-effects meta-analysis and used the inverse heterogeneity (IVhet) model to analyze the data.Results: Excluding an outlier study with an exceptionally high effect size for LS-BMD, we observed a statistically significant (p = .002) effect (EG vs. CG) of aquatic exercise for the LS-BMD (n = 10; SMD: 0.30; 95%-CI: 0.11-0.49). In parallel, the effect of aquatic exercise on FN-BMD was statistically significant (p = .034) compared to the CG (n = 10; SMD: 0.76, 95%-CI: 0.06-1.46). Of importance, heterogeneity between the trial results was negligible for LS (I-2: 7%) but substantial for FN-BMD (I-2: 87%). Evidence for risks of small study/publication bias was low for LS-BMD and considerable for FN-BMD.Discussion: In summary, the present systematic review and meta-analysis provides further evidence for the favorable effect of exercise on bone health in adults. Due to its safety and attractiveness, we particularly recommend water-based exercise for people unable, afraid or unmotivated to conduct intense land-based exercise programs.
CRIS-Team WoS Importer:2023-04-21

The effect of calyculin A on the dephosphorylation of the histone γ-H2AX after formation of X-ray-induced DNA double-strand breaks in human blood lymphocytes - Kuefner, Michael A.; Brand, Michael; Engert, Christina; Kappey, Hanna; Uder, Michael; Distel, Luitpold (International Journal of Radiation Biology, 2013)
Purpose: The purpose of this study was to investigate the effect of calyculin A on the number of γ-H2AX foci (phosphorylated histone variant 2AX) in lymphocytes after in vitro and in vivo irradiation with rather low doses as they are used in diagnostic and interventional radiology. Materials and methods: For in vitro experiments blood samples of 14 healthy volunteers were irradiated with different doses (10, 50, 100 mGy) and incubated with (0.01, 0.1, 1, 10 nM) or without calyculin A for up to 2 hours. Non-irradiated samples with and without calyculin A served as controls. For in vivo evaluation blood samples were collected from seven patients undergoing computed tomography (CT) both with 1 nM calyculin A containing vials and vials without calyculin A. Foci were quantified in isolated lymphocytes using γ-H2AX immunofluorescence microscopy. Results: 1 nM calyculin A led to a complete inhibition of γ-H2AX foci loss in irradiated samples whereas no inhibition of p53 binding protein 1 (53 BP1) foci was found. Lower concentrations of the phosphatase inhibitor did not have a sufficient effect on foci decrease. Calyculin A did not affect foci levels in non-irradiated samples. If no calyculin A was added into the vial before the blood draws detectable CT-induced foci levels were lower in all patients with a reduction of the medians of 35%. Conclusions: Using γ-H2AX immunofluorescence microscopy calyculin A can be a useful tool to mark the induced γ-H2AX foci after low dose irradiation and to avoid an underestimation of the real deoxyribonucleic acid (DNA) damage in in vitro and in vivo experiments. © 2013 Informa UK, Ltd.
CRIS-Team Scopus Importer:2023-03-08
Keywords: γ-H2AX; Calyculin A; DNA double-strand break repair

The Effect of Cooling Fluid Composition on Ablation Size in Hepatic Laser Ablation: A Comparative Study in an Ex Vivo Bovine Setting - Mankertz, Fiona; Bayerl, Nadine; Gemeinhardt, Ole; Hosten, Norbert; Kromrey, Marie Luise (Tomography, 2023)
PURPOSE: Hyperthermic ablation is a minimally invasive mode of tumour therapy which serves as a viable alternative to surgical intervention. However, one of the major drawbacks, besides the heat sink effect and the risk of damaging adjacent organs, is limited ablation size. The use of a cooling fluid during ablation has been shown to increase the ablation volume and decrease the carbonisation rate. The aim of this study was to investigate whether the composition of the cooling fluid has an effect on ablation size and carbonisation rate during hepatic laser ablation in an ex vivo bovine setting. METHOD: In this study bovine hepatic tissue was ablated in an ex vivo setting using an internally cooled laser applicator. A total of 45 tissue samples were assigned to three groups: 0.9% saline infusion (n = 15), distilled water infusion (n = 15) and a 50%/50% mixture of 0.9% saline and distilled water (n = 15). Ablation was conducted using a 1064 nm Nd:YAG laser at a wattage of 25 W and time interval of 10 min. The ablation volume and carbonisation rate were then measured and recorded through postprocedural MRI. One-way ANOVA and post-hoc testing were performed to assess the effect of the cooling fluid composition on the ablation volumes. RESULTS: We found that using a mixture of saline and distilled water as a cooling fluid during hyperthermic ablation resulted in a larger ablation volume (mean ± SD: 22.64 ± 0.99 cm3) when compared to saline infusion (21.08 ± 1.11 cm3) or distilled water infusion (20.92 ± 0.92 cm3). This difference was highly significant (p < 0.001). There was no significant difference in ablation size between the saline group and the distilled water group. The highest carbonisation rate occurred in the saline group (12/15), followed by the mixed infusion group (3/15) and the distilled water group (1/15). CONCLUSIONS: The results of this study suggest that cooling fluid composition during hepatic laser ablation affects ablation volume in an ex vivo bovine setting. There was no statistically significant difference when comparing ablation volumes during saline infusion and distilled water infusion, but the carbonisation rate was significantly higher when using saline. The combination of saline and distilled water in a 50%/50% mixture as cooling fluid appears to be an auspicious alternative, as ablation volumes created with it are larger when compared to saline and distilled water alone, while carbonisation rate remains low. This might improve patient outcome as well as patient eligibility for hyperthermic ablation.
CRIS-Team Scopus Importer:2023-09-29
Keywords: experimental radiology; hyperthermic ablation; interventional radiology; laser ablation; oncoradiology

The effect of different training frequency on bone mineral density in older adults. A comparative systematic review and meta-analysis - Zitzmann, Anna Lena; Shojaa, Mahdieh; Kast, Stephanie; Kohl, Matthias; von Stengel, Simon; Borucki, Diana; Gosch, Markus; Jakob, Franz; Kerschan-Schindl, Katharina; Kladny, Bernd; Lange, Uwe; Middeldorf, Stefan; et al. (Bone, 2022)
Exercise frequency is a key aspect of exercise protocols. In this systematic review and meta-analysis, we determined the effect of training frequency on (areal) bone mineral density (BMD) at lumbar spine (LS) and hip. Reviewing seven electronic databases up to April 2021, we conducted a systematic review of the literature according to the PRISMA statement. Inclusion criteria were (a) controlled exercise trials (b) with at least two study arms that compared low versus high exercise frequency, (c) an intervention ≥6 months and (d) BMD assessments at lumbar spine (LS) or hip. The analysis was conducted as a mixed-effect meta-analysis and used “type of exercise” and “study duration” as moderators in subgroup analyses. Standardized mean differences (SMD) for LS- and hip-BMD changes were defined as outcome measures. Seven studies with 17 exercise groups were included in the analysis. We observed significantly higher effects of high (≥2 sessions/week) vs. low net training frequency (1–<2 sessions/week) exercise on LS- (SMD 0.55, 95%-CI: 0.20–0.90) but not hip-BMD (0.19, −0.06 to 0.45). Study duration was found to be a significant moderator for the effect of training frequency at LS- but not hip-BMD. In parallel, the type of exercise moderately influences the effect of training frequency on LS- but not on hip-BMD. We observed a superior effect of higher net training frequency on BMD. Longer exercise exposition increases this effect. Considering e.g. holidays, indisposition or other temporary absence, exercise programs on osteoporosis should provide at least 3 sessions/week/year to allow a net training frequency of more than two sessions/week. Study registration: PROSPERO (CRD42021246804).
CRIS-Team Scopus Importer:2021-10-22
Keywords: Bone mineral density; Exercise; Guideline; Training frequency

The effect of renal denervation in moderate treatment-resistant hypertension with confirmed medication adherence - Ott, Christian; Mahfoud, Felix; Schmid, Andrea; Ewen, Sebastian; Toennes, Stefan W.; Meyer, Markus R.; Helfer, Andreas G.; Maurer, Hans H.; Ditting, Tilmann; Veelken, Roland; Zivanovic, Ina; Uder, Michael; et al. (Journal of Hypertension, 2016)
Data on the blood pressure (BP)-lowering effect of renal denervation (RDN) in moderate treatment-resistant hypertension (TRH) are limited. Moreover, change of adherence to medication, as one potential confounder of BP response, has never been analyzed rigorously in this group of patients. We analyzed the effect of RDN on BP in patients with moderate TRH who were retrospectively found to be completely adherent to their antihypertensive medication.Our study cohort comprised 40 patients with moderate TRH [office BP >= 140/90 but <160/100 mmHg and 24-h ambulatory BP monitoring (ABPM) >=130/80 mmHg] who underwent catheter-based RDN. Further major inclusion criterion was complete adherence to their medication (>=80% intake of their prescribed antihypertensive drugs) at baseline (assessed by retrospective toxicological analysis).Six months after RDN, office BP was reduced by -10/-6 mmHg (SBP: 149 ± 6 vs. 139 ± 15 mmHg; DBP: 81 ± 12 vs. 75 ± 10 mmHg; both P < 0.001) and 24-h ABPM by -7/-4 mmHg (SBP: 150 ± 14 vs. 143 ± 16 mmHg, P = 0.005; DBP: 82 ± 10 vs. 78 ± 9 mmHg, P = 0.009). Number of prescribed antihypertensive medication [6.0 (5.0-6.0) vs. 5.5 (5.0-6.0), P = 0.013] and adherence rate (95.2 ± 7.6 vs. 91.7 ± 13.9%, P = 0.065) was slightly reduced 6 months after RDN, both likely to underestimate the true BP reduction.Thus, our data indicate that even after given full respect to drug adherence as potential confounder of BP response after RDN, both office and 24-h ABPM were substantially reduced in patients with moderate TRH.
EVALuna2:3907

The Effects of a Normal Rate versus a Slow Intervalled Rate of Oral Nutrient Intake and Intravenous Low Rate Macronutrient Application on Psychophysical Function - Two Pilot Studies - Denzer-Lippmann, Melanie; Bachlechner, Stephan; Wielopolski, Jan; Fischer, Marie; Büttner, Andrea; Dörfler, Arnd; Schöfl, Christof; Muench, Gerald; Kornhuber, Johannes; Thürauf, Norbert (Frontiers in Psychology, 2017)
Stomach distension and energy per time are factors influencing satiety. Moreover, different rates of nutrient intake induce different stomach distension. The goal of our studies was to elucidate the influence of different oral rates of nutrient intake (normal rate versus slow intervalled rate; study I) and intravenous low rate macronutrient application (protein, carbohydrate, fat) or placebo (study II) on psychophysical function. The pilot studies investigated the effects of 1) study I: a mixed nutrient solution (1/3 protein, 1/3 fat, 1/3 carbohydrates) 2) study II: intravenous macronutrient infusions (protein, carbohydrate, fat) or placebo on psychophysical function (mood, hunger, food craving, alertness, smell intensity ratings and hedonic ratings) in human subjects. In study I 10 male subjects (age range: 21-30 years) completed the study protocol participating in both test conditions and in study II 20 male subjects (age range: 19-41 years) completed the study protocol participating in all test conditions. Additionally, metabolic function was analyzed and cognitive and olfactory tests were conducted twice starting 100 min before the beginning of the intervention and 240 min after. Psychophysical (mood, hunger, fat-, protein-, carbohydrate-, sweets- and vegetable-craving), alertness and metabolic function tests were performed seven times on each examination day. Greater effects on hunger and food cravings were observed for normal rate of intake compared to slow intervalled rate of intake and intravenous low rate macronutrient application. Our findings potentially confirm that volume of the food ingested and a higher rate of energy per time contribute to satiety during normal rate of food intake, while slow intervalled rate of food intake and intravenous low rate macronutrient application showed no effects on satiation. Our results motivate the view that a certain amount of volume of the food ingested and a certain energy per time ratio are necessary to reduce hunger and food craving.
EVALuna2:33741
Keywords: food ingestion; food intake; rate of food intake; psychophysical function; food craving; parenteral food administration; parenteral food intake

The Effects of Different Isocaloric Oral Nutrient Solutions on Psychophysical, Metabolic, Cognitive, and Olfactory Function in Young Male Subjects - Bachlechner, Stephan; Denzer-Lippmann, Melanie Y.; Wielopolski, Jan; Fischer, Marie; Büttner, Andrea; Dörfler, Arnd; Schöfl, Christof; Muench, Gerald; Kornhuber, Johannes; Thürauf, Norbert (Frontiers in Psychology, 2017)
Food intake influences human cognition, olfaction, hunger, and food craving. However, little research has been done in this field to elucidate the effects of different nutrients. Thus, the goal of our study was to investigate the effects of oral ingestion of different nutrient solutions on olfactory, cognitive, metabolic and psychophysical function. Twenty healthy men participated in our study employing a double-blind, cross-over, repeated measurement design. Participants were tested on four different study days. Each day participants received, in randomized order, one of three isocaloric (protein, carbohydrate or fat 600 kcal, 1,500mL) solutions or a placebo. Olfactory and cognitive tests (monitoring only) were conducted three times, i.e., 60min before the beginning of nutrient intake, following oral ingestion of the solution and 60, and 240min after. Psychophysical and metabolic function tests (active grehlin, desacyl ghrelin, insulin, glucagon, glucose, triglyceride, urea) were performed 7 times on each examination day (observation period: -60min, 0 = solution intake, +60, +120, +180, +240, and +300min). Ratings of hunger and food craving significantly differed over the observation period with lowest ratings following application of the protein solution. Highest ratings of craving were found following placebo intake. We further observed a significant positive correlation of active grehlin with hunger and fat, protein and sweets craving for each nutrient solution. Active grehlin significantly correlated with carbohydrate craving for carbohydrate and fat solution and with vegetable craving for fat solution only. Hunger hormone levels, hunger and food craving ratings demonstrated that the hierarchical order that appears in satiating efficiencies of isovolumetric-isocaloric ingested macronutrients is protein > fat > carbohydrate. Our study reveals that the type of nutrient exerts a significant influence on metabolic parameters, hunger and food craving.
Keywords: food ingestion; food intake; oral intake; olfaction; psychophysical function

The effects of RF coils and SAR supervision strategies for clinically applicable nonselective parallel-transmit pulses at 7 T - Herrler, Jürgen; Williams, Sydney N.; Liebig, Patrick; Ding, Belinda; McElhinney, Paul; Allwood-Spiers, Sarah; Meixner, Christian R.; Gunamony, Shajan; Nagel, Armin Michael; Dörfler, Arnd; Gumbrecht, Rene; Porter, David A.; et al. (Magnetic Resonance in Medicine, 2023)
Purpose: To investigate the effects of using different parallel-transmit (pTx) head coils and specific absorption rate (SAR) supervision strategies on pTx pulse design for ultrahigh-field MRI using a 3D-MPRAGE sequence. Methods: The PTx universal pulses (UPs) and fast online-customized (FOCUS) pulses were designed with pre-acquired data sets (B0, B1+ maps, specific absorption rate [SAR] supervision data) from two different 8 transmit/32 receive head coils on two 7T whole-body MR systems. For one coil, the SAR supervision model consisted of per-channel RF power limits. In the other coil, SAR estimations were done with both per-channel RF power limits as well as virtual observation points (VOPs) derived from electromagnetic field (EMF) simulations using three virtual human body models at three different positions. All pulses were made for nonselective excitation and inversion and evaluated on 132 B0, B1+, and SAR supervision datasets obtained with one coil and 12 from the other. At both sites, 3 subjects were examined using MPRAGE sequences that used UP/FOCUS pulses generated for both coils. Results: For some subjects, the UPs underperformed when simulated on a different coil from which they were derived, whereas FOCUS pulses still showed acceptable performance in that case. FOCUS inversion pulses outperformed adiabatic pulses when scaled to the same local SAR level. For the self-built coil, the use of VOPs showed reliable overestimation compared with the ground-truth EMF simulations, predicting about 52% lower local SAR for inversion pulses compared with per-channel power limits. Conclusion: FOCUS inversion pulses offer a low-SAR alternative to adiabatic pulses and benefit from using EMF-based VOPs for SAR estimation.
CRIS-Team Scopus Importer:2023-01-20
Keywords: fast online customized (FOCUS) pulses; parallel transmission (pTx); radiofrequency (RF) coils; UHF MRI; universal pulses (UPs); virtual observation points (VOPs)

The epidemiology of MRI-detected pelvic injuries in athletes in the Rio de Janeiro 2016 Summer Olympics - Heiß, Rafael; Guermazi, Ali; Jarraya, Mohamed; Engebretsen, Lars; Roemer, Frank (European Journal of Radiology, 2018)
OBJECTIVE: To describe the prevalence, severity and location of pelvic injuries, including hip, muscle and tendon pathologies, as assessed on MRI in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. METHODS: We analyzed all pelvic MRIs that were acquired for suspected injury as reported by the National Olympic Committee (NOC) medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic, using 3 T and 1.5 T MR scanners. Images were interpreted retrospectively according to standardized criteria. RESULTS: A total of 11,274 athletes participated in the Games, of which 40 (0,4%) were referred for a pelvic MRI. Thirty-seven of the 40 (92%) had at least one abnormal finding, and some had as many as 17, for an average of 4.1 pathologies per examination. Almost half of all abnormal findings were assessed as pre-existing (46%). The majority of acute/subacute injuries were observed in track and field athletes (44%), whereas the highest number of pre-existing findings was seen in ball-sports athletes (39%). Forty-seven per cent of all acute/subacute injuries were muscle injuries with the gluteus maximus muscle the most commonly affected. In contrast, most pre-existing findings were detected at the symphysis (59%). CONCLUSION: Our study demonstrated a high prevalence of both acute/subacute injuries and chronic changes in Olympic athletes undergoing pelvic MRI. Muscle injuries were the most common acute injuries, found mainly in track and field athletes. Most chronic changes were identified at the symphysis region in ball-sports athletes.
EVALuna2:35377

The epidemiology of MRI detected shoulder injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics - Murakami, Akira M.; Kompel, Andrew J.; Engebretsen, Lars; Li, Xinning; Forster, Bruce B.; Crema, Michel D.; Hayashi, Daichi; Jarraya, Mohamed; Roemer, Frank; Guermazi, Ali (BMC Musculoskeletal Disorders, 2018)
BACKGROUND: To use Magnetic Resonance Imaging (MRI) to characterize the severity, location, prevalence, and demographics of shoulder injuries in athletes at the Rio de Janeiro 2016 Summer Olympic Games. METHODS: This was a retrospective analysis of all routine shoulder MRIs obtained from the Olympic Village Polyclinic during the Rio 2016 Summer Olympics. Imaging was performed on 1.5 T and 3 T MRI, and interpretation was centrally performed by a board-certified musculoskeletal radiologist. Images were assessed for tendon, muscle, bone, bursal, joint capsule, labral, and chondral abnormality. RESULTS: A total of 11,274 athletes participated in the Games, of which 55 (5%) were referred for a routine shoulder MRI. Fifty-three (96%) had at least two abnormal findings. Seven (13%) had evidence of an acute or chronic anterior shoulder dislocation. Forty-nine (89%) had a rotator cuff partial tear and / or tendinosis. Subacromial / subdeltoid bursitis was present in 29 (40%). Thirty (55%) had a tear of the superior labrum anterior posterior (SLAP). CONCLUSION: Our study demonstrated a high prevalence of both acute and chronic shoulder injuries in the Olympic athletes receiving shoulder MRI. The high rates of bursal, rotator cuff, and labral pathology found in these patients implies that some degree of glenohumeral instability and impingement is occurring, likely due to fatigue and overuse of the dynamic stabilizers. Future studies are needed to better evaluate sport-specific trends of injury.
EVALuna2:35376

The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry - Griessenauer, C. J.; Möhlenbruch, M. A.; Hendrix, P.; Ulfert, C.; Islak, C.; Sonnberger, M.; Engelhorn, Tobias; Müller-Thies-Broussalis, E.; Finkenzeller, T.; Holtmannspötter, M.; Buhk, J. H.; Reith, W.; et al. (American Journal of Neuroradiology, 2020)
BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location. MATERIALS AND METHODS: Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated. RESULTS: Eighty-four patients (median age, 54 years) with 84 posterior circulation aneurysms were treated with the FRED. A total of 25 aneurysms (29.8%) had previously ruptured, even though most aneurysms were diagnosed incidentally (45.2%). The intradural vertebral artery was the most common location (50%), and saccular, the most common morphology (40.5%). The median size was 7 mm. There were 8 (9.5%) symptomatic thromboembolic and no hemorrhagic complications. Thromboembolic complications occurred mostly (90.9%) in nonsaccular aneurysms. On last follow-up at a median of 24 months, 78.2% of aneurysms were completely occluded. Functional outcome at a median of 27 months was favorable in 94% of patients. All mortalities occurred in patients with acute subarachnoid hemorrhage and its sequelae. CONCLUSIONS: The largest cohort of posterior circulation aneurysms treated with the FRED to date demonstrated favorable safety and efficacy profiles of the device for this indication. Treatment in the setting of acute subarachnoid hemorrhage was strongly related to mortality, regardless of whether procedural complications occurred.
CRIS-Team Scopus Importer:2020-04-28

The FRESH Study: Treatment of Intracranial Aneurysms with the New FRED X Flow Diverter with Antithrombotic Surface Treatment Technology-First Multicenter Experience in 161 Patients - Vollherbst, D. F.; Lücking, Hannes; Duplessis, J.; Sonnberger, M.; Maurer, C.; Kocer, N.; Killer-Oberpfalzer, M.; Rautio, R.; Valvassori, L.; Berlis, A.; Gasser, S.; Gatt, S.; et al. (American Journal of Neuroradiology, 2023)
BACKGROUND AND PURPOSE: Flow diverters with antithrombotic coatings are increasingly used to improve the safety of flow diverter treatments of intracranial aneurysms. This study aimed to investigate the safety and short-term efficacy of the new FRED X flow diverter. MATERIALS AND METHODS: Medical charts and procedural and imaging data of a consecutive series of patients with intracranial aneurysms who were treated with the FRED X at 9 international neurovascular centers were retrospectively analyzed. RESULTS: One hundred sixty-one patients (77.6% women; mean age, 55 years) with 184 aneurysms (11.2% acutely ruptured) were included in this study. Most aneurysms were located in the anterior circulation (77.0%), most frequently at the ICA (72.7%). The FRED X was successfully implanted in all procedures. Additional coiling was performed in 29.8%. In-stent balloon angioplasty was necessary in 2.5%. The rate of major adverse events was 3.1%. Thrombotic events occurred in 7 patients (4.3%) with 4 intra- and 4 postprocedural in-stent thromboses, respectively (1 patient had both peri- and postprocedural thrombosis). Of these thrombotic events, only 2 (1.2%) led to major adverse events (ischemic strokes). Postinterventional neurologic morbidity and mortality were observed in 1.9% and 1.2%, respectively. The rate of complete aneurysm occlusion after a mean follow-up of 7.0 months was 66.0%. CONCLUSIONS: The new FRED X is a safe and feasible device for aneurysm treatment. In this retrospective multicenter study, the rate of thrombotic complications was low, and the short-term occlusion rates are satisfactory.
CRIS-Team Scopus Importer:2023-04-21

The German COVID-19 Digital Contact Tracing App: A Socioeconomic Evaluation - Ellmann, Stephan; Maryschok, Markus; Schöffski, Oliver; Emmert, Martin (International Journal of Environmental Research and Public Health, 2022)
The COVID-19 pandemic posed challenges to governments in terms of contact tracing. Like many other countries, Germany introduced a mobile-phone-based digital contact tracing solution (“Corona Warn App”; CWA) in June 2020. At the time of its release, however, it was hard to assess how effective such a solution would be, and a political and societal debate arose regarding its efficiency, also in light of its high costs. This study aimed to analyze the effectiveness of the CWA, considering prevented infections, hospitalizations, intensive care treatments, and deaths. In addition, its efficiency was to be assessed from a monetary point of view, and factors with a significant influence on the effectiveness and efficiency of the CWA were to be determined. Mathematical and statistical modeling was used to calculate infection cases prevented by the CWA, along with the numbers of prevented complications (hospitalizations, intensive care treatments, deaths) using publicly available CWA download numbers and incidences over time. The monetized benefits of these prevented cases were quantified and offset against the costs incurred. Sensitivity analysis was used to identify factors critically influencing these parameters. Between June 2020 and April 2022, the CWA prevented 1.41 million infections, 17,200 hospitalizations, 4600 intensive care treatments, and 7200 deaths. After offsetting costs and benefits, the CWA had a net present value of EUR 765 m in April 2022. Both the effectiveness and efficiency of the CWA are decisively and disproportionately positively influenced by the highest possible adoption rate among the population and a high rate of positive infection test results shared via the CWA.
CRIS-Team Scopus Importer:2022-11-25
Keywords: Corona Warn App; cost–benefit analysis; COVID-19; digital contact tracing; utility analysis

The hyperintense acute reperfusion marker on fluid-attenuated inversion recovery magnetic resonance imaging is caused by gadolinium in the cerebrospinal fluid - Köhrmann, Martin; Struffert, Tobias; Frenzel, Thomas; Schwab, Stefan; Dörfler, Arnd (Stroke, 2012)
Background and PurposeS-: The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery MRI is believed to be caused by gadolinium-based contrast agents crossing a disrupted blood-brain barrier. However, this hypothesis has never been directly verified in humans. Methods-: In this study, we analyzed cerebrospinal fluid samples of patients with HARM on imaging regarding the presence and concentration of gadolinium-based contrast agents. Results-: Gadobutrol was found in concentrations of approximately 50 μmol/L. Using phantom MRI experiments, we demonstrate that the detected concentrations are consistent with the observed HARM imaging pattern. Conclusions-: Our study yields first direct evidence in humans that the imaging phenomenon HARM is indeed caused by leakage of gadolinium-based contrast agents into the cerebrospinal fluid. © 2011 American Heart Association. All rights reserved.
CRIS-Team Scopus Importer:2022-08-05
Keywords: FLAIR; hyperintensive acute reperfusion marker; MRI

The Impact of Burst Motor Cortex Stimulation on Cardiovascular Autonomic Modulation in Chronic Pain: A Feasibility Study for a New Approach to Objectively Monitor Therapeutic Effects - Borutta, Matthias; Köhn, Julia; Souza de Oliveira, Daniela; Del Vecchio, Alessandro; Engelhorn, Tobias; Schwab, Stefan; Buchfelder, Michael; Kinfe, Thomas Mehari (Pain and Therapy, 2023)
Introduction: Chronic refractory pain of various origin occurs in 30–45% of pain patients, and a considerable proportion remains resistant to pharmacological and behavioral therapies, requiring adjunctive neurostimulation therapies. Chronic pain is known to stimulate sympathetic outflow, yet the impact of burst motor cortex stimulation (burstMCS) on objectifiable autonomic cardiovascular parameters in chronic pain remains largely unknown. Methods: In three patients with chronic pain (2 facial pain/1 post-stroke pain), we compared pain intensity using a visual analog scale (VAS 1–10) and parameters of autonomic cardiovascular modulation at supine rest, during parasympathetic challenge with six cycles per minute of metronomic deep breathing, and during sympathetic challenge (active standing) at baseline and after 4 months of burstMCS compared to age-/gender-matched healthy controls. Results: While two out of three patients were responsive after 4 months of adjunctive burstMCS (defined as pain reduction of > 30%), no differences were found in any of the three patients regarding the R-R intervals of adjacent QRS complexes (RRI, 642 vs. 676 ms) and blood pressure (BP, 139/88 vs. 141/90 mmHg). Under resting conditions, parameters of parasympathetic tone [normalized units of high-frequency oscillations of RRI (RRI-HFnu power) 0.24 vs. 0.38, root-mean-square differences of successive RRI (RRI-RMSSD) 7.7 vs. 14.7 ms], total autonomic cardiac modulation [RRI total power 129.3 vs. 406.2 ms2, standard deviation of RRI (RRI-SD) 11.6 vs. 18.5 ms, coefficient of variation of RRI (RRI-CV) 1.9 vs. 3.7%], and baroreceptor reflex sensitivity (BRS, 1.9 vs. 2.3 ms/mmHg) increased, and parameters of sympathetic tone [normalized units of low-frequency oscillations of RRI (RRI-LFnu power) 0.76 vs. 0.62] and sympatho-vagal balance [ratio of RR-LF to RRI-HF power (RRI-LF/HF ratio) 3.4 vs. 1.9] decreased after 4 months of burstMCS. Low-frequency oscillations of systolic blood pressure (SBP-LF power), a parameter of sympathetic cardiovascular modulation, increased slightly (17.6 vs. 20.4 mmHg2). During parasympathetic stimulation, the expiratory–inspiratory ratio (E/I ratio) increased slightly, while upon sympathetic stimulation, the ratio between the shortest RRI around the 15th heartbeat and the longest RRI around the 30th heartbeat after standing up (RRI 30/15 ratio) remained unchanged. Conclusion: Four months of adjunctive burstMCS was associated with an increase in parameters reflecting both total and parasympathetic autonomic modulation and baroreceptor reflex sensitivity. In contrast, sympathetic tone declined in our three patients, suggesting stimulation-associated improvement not only in subjectively perceived VAS pain scores, but also in objectifiable parameters of autonomic cardiovascular modulation.
CRIS-Team Scopus Importer:2023-08-11
Keywords: Autonomic cardiovascular modulation; Burst motor cortex stimulation; Chronic post stroke pain; Objective outcome measures

The impact of dietary isoflavonoids on malignant brain tumors - Sehm, Tina; Fan, Zheng; Weiss, Ruth; Schwarz, Marc; Engelhorn, Tobias; Hore, Nirjhar; Dörfler, Arnd; Buchfelder, Michael; Eyüpoglu, Ilker Yasin; Savaskan, Nic E. (Cancer Medicine, 2014)
Poor prognosis and limited therapeutic options render malignant brain tumors one of the most devastating diseases in clinical medicine. Current treatment strategies attempt to expand the therapeutic repertoire through the use of multimodal treatment regimens. It is here that dietary fibers have been recently recognized as a supportive natural therapy in augmenting the body's response to tumor growth. Here, we investigated the impact of isoflavonoids on primary brain tumor cells. First, we treated glioma cell lines and primary astrocytes with various isoflavonoids and phytoestrogens. Cell viability in a dose-dependent manner was measured for biochanin A (BCA), genistein (GST), and secoisolariciresinol diglucoside (SDG). Dose-response action for the different isoflavonoids showed that BCA is highly effective on glioma cells and nontoxic for normal differentiated brain tissues. We further investigated BCA in ex vivo and in vivo experimentations. Organotypic brain slice cultures were performed and treated with BCA. For in vivo experiments, BCA was intraperitoneal injected in tumor-implanted Fisher rats. Tumor size and edema were measured and quantified by magnetic resonance imaging (MRI) scans. In vascular organotypic glioma brain slice cultures (VOGIM) we found that BCA operates antiangiogenic and neuroprotective. In vivo MRI scans demonstrated that administered BCA as a monotherapy was effective in reducing significantly tumor-induced brain edema and showed a trend for prolonged survival. Our results revealed that dietary isoflavonoids, in particular BCA, execute toxicity toward glioma cells, antiangiogenic, and coevally neuroprotective properties, and therefore augment the range of state-of-the-art multimodal treatment approach.
EVALuna2:22829

The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses - Vitali, Francesco; Strobel, Deike; Frulloni, Luca; Heinrich, Marc Christopher; Pfeifer, Lukas; Görtz, Rüdiger; Hundorfean, Gheorghe; Wachter, David Lukas; Wachter, David; Grützmann, Robert; Bernatik, Thomas; Neurath, Markus; et al. (Medical Ultrasonography, 2018)
AIMS: Endosonography (EUS) is one of the main diagnostic tools for the differential diagnosis of pancreatic masses. The aim of our study was to describe the value of this technique in the work-up of solid pancreatic lesions, considering the influence of the morphological evidence of pancreatic inflammation in the diagnostic process. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data in our tertiary University center. From March 2007 to October 2015, 218 patients underwent EUS for a suspected solid pancreatic neoplasm (based on previous cross-sectional imaging results, idiopatic acute pancreatitis, weight loss, pancreatic hyperenzymemia, painless jaundice or elevated Ca 19-9 values). RESULTS: Malignant lesions were diagnosed in 98 (45%) patients. Sensitivity of EUS for malignancy was 91% and specificity 89.2%. Signs of pancreatic inflammation in the surrounding pancreatic parenchyma around the focal lesion were present in 97 patients (44.4%)(more often in men, smokers and drinkers, and the most common etiology was focal chronic pancreatitis) and in these patients the sensitivity and sensibility dropped to 44% and 87.1%, respectively. In patients without signs of pancreatic inflammation, the pancreatic focal lesions were adenocarcinoma, neuroendocrine tumor, ventral/dorsal split, non-pancreatic pathology, pancreatic lipomatosis and autoimmune pancreatitis. CONCLUSION: Pancreatic inflammation (either focal or involving the whole gland) lowers the diagnostic sensibility of EUS in the work- up of pancreatic masses suspected for cancer, requiring further invasive diagnostic methods. Focal autoimmune pancreatitis and paraduodenal pancreatitis are still confused with pancreatic cancer, even in the absence of pancreatic inflammation.
EVALuna2:35194

The infectious propagules of Aspergillus fumigatus are coated with antimicrobial peptides - Dümig, Michaela; Binder, Jasmin; Gaculenko, Anastasia; Daul, Franziska; Winandy, Lex; Hasenberg, Mike; Gunzer, Matthias; Fischer, Reinhard; Künzler, Markus; Krappmann, Sven (Cellular Microbiology, 2021)
Fungal spores are unique cells that mediate dispersal and survival in the environment. For pathogenic fungi encountering a susceptible host, these specialised structures may serve as infectious particles. The main causative agent of the opportunistic disease aspergillosis, Aspergillus fumigatus, produces asexual spores, the conidia, that become dissipated by air flows or water currents but also serve as propagules to infect a susceptible host. We demonstrate that the defX gene of this mould encodes putative antimicrobial peptides resembling cysteine-stabilised (CS)αβ defensins that are expressed in a specific spatial and temporal manner in the course of asexual spore formation. Localisation studies on strains expressing a fluorescent proxy or tagged defX alleles expose that these antimicrobial peptides are secreted to coat the conidial surface. Deletion mutants reveal that the spore-associated defX gene products delay the growth of Gram-positive Staphylococcus aureus and demonstrate that the defX gene and presumably its encoded spore-associated defensins confer a growth advantage to the fungal opponent over bacterial competitors. These findings have implications with respect to the ecological niche of A. fumigatus that serves as a ‘virulence school’ for this human pathogenic mould; further relevance is given for the infectious process resulting in aspergillosis, considering competition with the host microbiome or co-infecting microorganisms to break colonisation resistance at host surfaces.
CRIS-Team Scopus Importer:2021-03-12
Keywords: aspergillosis; defensin-like peptide; fungal virulence

The JAK1/3 Inhibitor to Tofacitinib Suppresses T Cell Homing and Activation in Chronic Intestinal Inflammation - Gerlach, Katharina; Lechner, Kristina; Popp, Vanessa; Offensperger, Laura; Zundler, Sebastian; Wiendl, Maximilian; Becker, Emily; Atreya, Raja; Rath, Timo; Neurath, Markus; Weigmann, Benno (Journal of Crohns & Colitis, 2021)
Background and Aims: The molecular mechanism of action of the Janus kinase [JAK] inhibitor tofacitinib is poorly understood. Methods: Here we analysed the inhibitory effect of tofacitinib on mucosal and blood T cells from patients with ulcerative colitis [UC]. Furthermore, tofacitinib treatment was analysed in experimental colitis models and wound healing. Additionally, tofacitinib effects were analysed in bioassays. Results: Tofacitinib significantly reduced T cell-derived inflammatory cytokine production [Th2, Th9, Th17] in patients with active UC. Additionally, impaired expression of the homing receptors alpha4/beta1 and alpha4/beta7, as well as reduced gut homing capacity of T cells in a humanised mouse model of colitis, were observed. Tofacitinib suppressed acute and chronic oxazolone colitis, compared with untreated wild-type mice, associated with downregulation of cytokines produced by Th2, Th9, and Th17 cells. Functionally, tofacitinib induced apoptosis of intestinal epithelial cells and prevented mucosal wound healing in vivo at higher concentration. Thus, our findings suggest that tofacitinib is quite effective in protecting from colitis, by inhibition of a bundle of T cell-derived cytokines like IL-5, IL-6, IL-9, IL-13, and IL-17A. Conclusions: Application of tofacitinib emerges as an attractive concept for treatment of chronic intestinal inflammation at lower concentrations, whereas higher concentrations require attention due to prolonged wound healing.
CRIS-Team Scopus Importer:2021-05-07
Keywords: cytokines; inflammatory bowel disease; T cells; Tofacitinib; wound healing

The Joint Association of Steps/day and Typical Sedentary Bout Length with Worsening Knee Cartilage Damage over Two Years: The MOST Study - Voinier, Dana; Neogi, Tuhina; Stefanik, Joshua; Guermazi, Ali; Roemer, Frank; Master, Hiral; Thoma, Louise; Christiansen, Meredith; Jakiela, Jason; Nevitt, Michael; Lewis, Cora; Torner, James; et al. (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

The macrophage phenotype and inflammasome component NLRP3 contributes to nephrocalcinosis-related chronic kidney disease independent from IL-1-mediated tissue injury - Anders, Hans-Joachim; Suarez-Alvarez, Beatriz; Grigorescu, Melissa; Foresto-Neto, Orestes; Steiger, Stefanie; Desai, Jyaysi; Marschner, Julian A.; Honarpisheh, Mohsen; Shi, Chongxu; Jordan, Jutta; Müller, Lisa; Burzlaff, Nicolai; et al. (Kidney International, 2018)
Primary/secondary hyperoxalurias involve nephrocalcinosis-related chronic kidney disease (CKD) leading to end-stage kidney disease. Mechanistically, intrarenal calcium oxalate crystal deposition is thought to elicit inflammation, tubular injury and atrophy, involving the NLRP3 inflammasome. Here, we found that mice deficient in NLRP3 and ASC adaptor protein failed to develop nephrocalcinosis, compromising conclusions on nephrocalcinosis-related CKD. In contrast, hyperoxaluric wild-type mice developed profound nephrocalcinosis. NLRP3 inhibition using the ?-hydroxybutyrate precursor 1,3-butanediol protected such mice from nephrocalcinosis-related CKD. Interestingly, the IL-1 inhibitor anakinra had no such effect, suggesting IL-1-independent functions of NLRP3. NLRP3 inhibition using 1,3-butanediol treatment induced a shift of infiltrating renal macrophages from pro-inflammatory (CD45F4/80CD11bCX3CR1CD206) and pro-fibrotic (CD45F4/80CD11bCX3CR1CD206TGF?) to an anti-inflammatory (CD45F4/80CD11bCD206TGF?) phenotype, and prevented renal fibrosis. Finally, in vitro studies with primary murine fibroblasts confirmed the non-redundant role of NLRP3 in the TGF-? signaling pathway for fibroblast activation and proliferation independent of the NLRP3 inflammasome complex formation. Thus, nephrocalcinosis-related CKD involves NLRP3 but not necessarily via intrarenal IL-1 release but rather via other biological functions including TGFR signaling and macrophage polarization. Hence, NLRP3 may be a promising therapeutic target in hyperoxaluria and nephrocalcinosis.
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The new radiation protection framework since 2019 - Implementation in Germany and comparison of some aspects in seven European countries Das neue Strahlenschutzrecht ab 2019 Umsetzung in Deutschland und Vergleich einzelner Aspekte in 7 europäischen Ländern - Loose, Reinhard; Wucherer, Michael; Walz, Michael; Adamus, Ralf (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2020)
Purpose The implementation of EU Directive 2013/59 EURATOM (EU-BSS) of 2014 led to a reorganization of radiation protection legislation in Germany in the form of a new radiation protection law Strahlenschutzgesetz (StrlSchG) of 2017 and a new radiation protection ordinance Strahlenschutzverordnung (StrlSchV) of 2018. For application of ionizing radiation in medicine these changes affect radiology, nuclear medicine and radiotherapy. A comparison between the old and the new legal system analyses changes that are relevant for diagnostic and interventional radiology. For the important new regulation of unintended exposures, a comparison is made with the implementation of Art.63 EU-BSS in 7 European countries. Material and methods The provisions of the Röntgenverordnung (RöV) and the old Strahlenschutzverordnung (StrlSchV alt), which were valid until 2018, are compared with the new legislation of StrlSchG and StrlSchV for changes in radiation protection for patients, the population and occupational radiation protection of staff members. The occupational dose limit of the eye lens was reduced. The reduction by a factor of 7.5 results in new requirements for radiation protection equipment. New requirements in teleradiology are compared with the previous regulation, as well as the necessary involvement of medical physics experts (MPE) in high dose procedures, such as CT and fluoroscopic interventions. The regulation for unintended exposures of the German StrlSchV are analyzed in terms of their reporting criteria. Results The principles of medical radiation protection in Germany have not changed as a result of the new radiation protection legislation from 2019 onwards. However, there are a number of changes and new requirements that must be considered and implemented. Important points are e.g. new regulations on teleradiology, early detection of diseases in asymptomatic individuals and reporting of unintended exposure of patients. As all new regulations are no longer found in only one single regulation, both knowledge of the StrlSchG and the StrlSchV are necessary. Key points: The EU Directive 2013/59 EURATOM (EU-BSS) was transposed into the new German radiation protection law 2018 The basic regulations of the RöV and old StrlSchV remain unchanged Newly added regulations must be known and implemented in practice Many regulations of the EU-BSS are so vaguely formulated that they allow a wide scope for national implementation Citation Format Loose R, Wucherer M, Walz M etal. The new radiation protection framework since 2019 - Implementation in Germany and comparison of some aspects in seven European countries. Fortschr Röntgenstr 2020; 192: 1036-1045.
CRIS-Team Scopus Importer:2020-11-20
Keywords: EU Directive 2013/59 EURATOM; medicolegal Issues; radiation protection law; radiation protection ordinance; radiation safety

The opportunistic pathogen Aspergillus fumigatus coats its infectious propagules with antimicrobial peptides - Duemig, Michaela; Binder, Johannes; Gaculenko, Anastasia; Daul, F.; Hasenberg, M.; Gunzer, M.; Krappmann, Sven (2018)
EVALuna2:213342

The POST trial: initial post-market experience of the Penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe - Tarr, Robert; Hsu, Dan; Kulcsar, Zsolt; Bonvin, Christophe; Rufenacht, Daniel; Alfke, Karsten; Stingele, Robert; Jansen, Olav; Frei, Donald; Bellon, Richard; Madison, Michael; Struffert, Tobias; et al. (Journal of Neurointerventional Surgery, 2018)
BACKGROUND AND PURPOSE: The purpose of this study was to assess the initial post-market experience of the device and how it is compared with the Penumbra Pivotal trial used to support the 510k application. METHODS: A retrospective case review of 157 consecutive patients treated with the Penumbra system at seven international centers was performed. Primary endpoints were revascularization of the target vessel (TIMI score of 2 or 3), good functional outcome as defined by a modified Rankin scale (mRS) score of ≤2 and incidence of procedural serious adverse events. Results were compared with those of the Penumbra pivotal trial. RESULTS: A total of 157 vessels were treated. Mean baseline values at enrollment were: age 65 years, NIHSS score 16. After use of the Penumbra system, 87% of the treated vessels were revascularized to TIMI 2 (54%) or 3 (33%) as compared with 82% reported in the Pivotal trial. Nine procedural serious adverse events were reported in 157 patients (5.7%). All-cause mortality was 20% (32/157), and 41% had a mRS of ≤2 at 90-day follow-up as compared with only 25% in the Pivotal trial. Patients who were successfully revascularized by the Penumbra system had significantly better outcomes than those who were not. CONCLUSION: Initial post-market experience of the Penumbra system revealed that the revascularization rate and safety profile of the device are comparable to those reported in the Pivotal trial. However, the proportion of patients who had good functional outcome was higher than expected.
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The potential of predictive and prognostic breast MRI (P2-bMRI) - Dietzel, Matthias; Trimboli, Rubina Manuela; Zanardo, Moreno; Schultz-Wendtland, Rudiger; Uder, Michael; Clauser, Paola; Sardanelli, Francesco; Baltzer, Pascal A. T. (European Radiology Experimental, 2022)
Magnetic resonance imaging (MRI) is an important part of breast cancer diagnosis and multimodal workup. It provides unsurpassed soft tissue contrast to analyse the underlying pathophysiology, and it is adopted for a variety of clinical indications. Predictive and prognostic breast MRI (P2-bMRI) is an emerging application next to these indications. The general objective of P2-bMRI is to provide predictive and/or prognostic biomarkers in order to support personalisation of breast cancer treatment. We believe P2-bMRI has a great clinical potential, thanks to the in vivo examination of the whole tumour and of the surrounding tissue, establishing a link between pathophysiology and response to therapy (prediction) as well as patient outcome (prognostication). The tools used for P2-bMRI cover a wide spectrum: standard and advanced multiparametric pulse sequences; structured reporting criteria (for instance BI-RADS descriptors); artificial intelligence methods, including machine learning (with emphasis on radiomics data analysis); and deep learning that have shown compelling potential for this purpose. P2-bMRI reuses the imaging data of examinations performed in the current practice. Accordingly, P2-bMRI could optimise clinical workflow, enabling cost savings and ultimately improving personalisation of treatment. This review introduces the concept of P2-bMRI, focusing on the clinical application of P2-bMRI by using semantic criteria.
CRIS-Team WoS Importer:2022-09-02

The relation of aortic dimensions and obesity in adults with Marfan or Loeys-Dietz syndrome - Suleiman, Mathieu; Freilinger, Sebastian; Meierhofer, Christian; May, Matthias; Bischoff, Gert; Ewert, Peter; Freiberger, Annika; Huntgeburth, Michael; Kaemmerer, Ann-Sophie; Marwan, Mohamed; Nagdyman, Nicole; Roth, Jan-Peter; et al. (Cardiovascular Diagnosis and Therapy, 2022)
Background: Aortic aneurysm and aortic dissection can have a major impact on the life expectancy of Marfan syndrome (MFS) or Loeys-Dietz syndrome (LDS) patients. Although obesity can influence the development of aortic complications, evidence on whether obesity influences the development of aortic aneurysm or dissection in MFS and LDS is limited. The aim of the present study was to elucidate the relationship between aortic size and body composition, assessed by modern bioelectrical impedance analysis (BIA) in MFS/LDS-patients.Methods: In this exploratory cross-sectional study in MFS or LDS patients, enrolled between June 2020 and May 2022, 34 patients received modern BIA and magnetic resonance imaging (MRI) (n=32) or computed tomography (CT) imaging (n=2) of the entire aorta. A P value of <0.05 was considered significant.Results: Fifty-one patients (66% female; mean age: 37.7 +/- 11.7; range, 17-68 years) with MFS or LDS were enrolled; 34 patients, 27 with MFS and 7 with LDS, underwent aortic MRI or CT scanning. The mean aortic length was 503.7 +/- 58.7 mm, and the mean thoracic aortic length and abdominal aortic length were 351.5 +/- 52.4 and 152.2 +/- 27.4 mm, respectively. The aortic bulb and the ascending aorta were measured only in the non-surgically repaired patients. Fifteen MFS (88.2%) and two LDS (40.0%) patients had an aortic aneurysm. In these, the aortic bulb tended to be larger in MFS than in LDS patients [42.6x41.9x41.2 vs. 37.8x37.4x36.8 mm; P=0.07 (-1.1; 9.1); P=0.07 (-1.2; 8.4); P=0.07 (-1.5; 7.9)]. BIA revealed mean body fat levels of 31.6%+/- 8.7% (range, 9.5-53.5%), indicating that 18 patients (52.9%) were obese. There was a significant correlation between body fat content and thoracic aortic length (R=-0.377; P=0.02), muscle mass and total aortic length (R=0.359; P=0.03), thoracic aortic length (R=0.399; P=0.02), extracellular mass (ECM), and total aortic length (R=0.354; P=0.04) , connective tissue and aortic diameters at the aortic arch (R=0.511; P=0.002), aortic isthmus (R=0.565; P<0.001), and abdominal aorta (R=0.486; P=0.004). Older age was correlated with wider aortic arch, isthmus, and abdominal aorta. Male patients had a longer aorta.Conclusions: While a slender habitus is commonly known for MFS and LDS patients, our data show that many MFS and LDS patients (especially female) do not fit this phenotypic characteristic and are obese, which is associated with a more severe aortic phenotype. This topic should be included in the clinical assessment of affected MFS and LDS patients, in addition to measurement of the aortic diameters. Physicians should systematically screen MFS and LDS patients for obesity, educate them about the potential risk of resulting aortic complications, and encourage them to adopt a healthy lifestyle, that includes (mild) exercise and a balanced diet.
CRIS-Team WoS Importer:2023-02-03
Keywords: Adults with connective tissue disease; Marfan syndrome (MFS); Loeys-Dietz syndrome (LDS); body composition; obesity

The relation of MRI-detected structural damage in the medial and lateral patellofemoral joint to knee pain: the Multicenter and Framingham Osteoarthritis Studies - Stefanik, J. J.; Gross, K. D.; Guermazi, Ali; Felson, D. T.; Roemer, Frank; Zhang, Y.; Niu, J.; Segal, N. A.; Lewis, C. E.; Nevitt, M.; Neogi, Tuhina (Osteoarthritis and Cartilage, 2015)
To examine the relation of cartilage loss and bone marrow lesions (BMLs) in the medial and lateral patellofemoral joint (PFJ) to knee pain.We categorized the location of full-thickness cartilage loss and BMLs in the PFJ on knee magnetic resonance imaging (MRIs) from the Multicenter Osteoarthritis (MOST) and Framingham Osteoarthritis (FOA) Studies as no damage, isolated medial, isolated lateral, or both medial and lateral (mixed). We determined the relation of MRI lesions in each PFJ region to prevalent knee pain. Differences in knee pain severity were compared among categories of PFJ full-thickness cartilage loss and BMLs using quantile regression.In MOST (n = 1137 knees), compared with knees without full-thickness cartilage loss, knees with isolated lateral or mixed PFJ full-thickness cartilage loss had 1.9 (1.3, 2.8) and 1.9 (1.2, 2.9) times the odds of knee pain, respectively, while isolated medial cartilage loss had no association with knee pain. BMLs in both the medial and lateral PFJ had 1.5 (1.1, 2.0) times the odds of knee pain compared with knees without BMLs. Knee pain severity was lowest in knees with isolated medial PFJ cartilage loss or BMLs. In FOA (n = 934 knees), neither isolated medial nor lateral cartilage loss was associated with knee pain, whereas isolated BMLs in either region were associated with pain.Results were not completely concordant but suggest that knee pain risk and severity is greatest with cartilage loss isolated to (MOST) or inclusive of (MOST and FOA) the lateral PFJ. While BMLs in either the medial or lateral PFJ are related to pain.
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The relationship between subchondral sclerosis detected with MRI and cartilage loss in a cohort of subjects with knee pain: the knee osteoarthritis progression (KOAP) study - Crema, M. D.; Cibere, J.; Sayre, E. C.; Roemer, Frank; Wong, H.; Thorne, A.; Singer, J.; Esdaile, J. M.; Marra, M. D.; Kopec, J. A.; Nicolaou, S.; Guermazi, A. (Osteoarthritis and Cartilage, 2014)
To assess the association between subchondral sclerosis detected at baseline with MRI and cartilage loss over time in the same region of the knee in a cohort of subjects with knee pain.163 subjects with knee pain participated in a longitudinal study to assess knee osteoarthritis progression (KOAP). Subjects received baseline knee radiographs as well as baseline and 3-year follow-up MRI examinations. Baseline subchondral sclerosis and bone marrow lesions (BMLs) were scored semiquantitatively on MRI in each region from 0 to 3. Cartilage morphology at baseline and follow-up was scored semiquantitatively from 0 to 4. The association between baseline subchondral sclerosis and cartilage loss in the same region of the knee was evaluated using logistic regression, adjusting the results for age, gender, body mass index, and the presence of concomitant BMLs.The prevalence of subchondral sclerosis detected by MRI in the regions of the knee varied between 1.6% (trochlea) and 17% (medial tibia). The occurrence of cartilage loss over time in regions varied between 6% (lateral tibia) and 13.1% (medial femur). The prevalence of radiographically-detected subchondral sclerosis in compartments varied from 2.9% (patellofemoral) to 14.2% (medial tibiofemoral). In logistic regression models, there were no significant associations between baseline subchondral sclerosis detected by MRI and cartilage loss in the same region of the knee.Baseline subchondral sclerosis as detected by MRI did not increase the risk of cartilage loss over time.
EVALuna2:14457

THE RELATIONSHIP BETWEEN THE POSTERIOR RADIOSCAPHOID ANGLE AND THE SEVERITY OF CARTILAGE DAMAGE AND SCAPHOLUNATE DIASTASIS AFTER SCAPHOLUNATE LIGAMENT TEARS - Crema, M. D.; Balci, D.; Miquel, A.; Roemer, Frank; Guermazi, A.; Arrive, L. (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-06-02

The role of imaging in osteoarthritis - Roemer, Frank; Eckstein, Felix; Hayashi, Daichi; Guermazi, Ali (Best Practice & Research in Clinical Rheumatology, 2014)
Osteoarthritis (OA) is the most prevalent joint disorder with no approved disease-modifying treatment available. The importance of imaging in assessing all joint structures involved in the disease process, including articular cartilage, meniscus, subarticular bone marrow, and synovium for diagnosis, prognostication, and follow-up, has been well recognized. In daily clinical practice, conventional radiography is still the most commonly used imaging technique for the evaluation of a patient with known or suspected OA and radiographic outcome measures are still the only approved end point by regulatory authorities in clinical trials. The ability of magnetic resonance imaging (MRI) to visualize all joint structures in three-dimensional fashion including tissue ultrastructure has markedly deepened our understanding of the natural history of the disease. This article describes the roles and limitations of different imaging modalities for clinical practice and research in OA, with a focus on radiography and MRI and an emphasis on the knee joint.
EVALuna2:14437

The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA - Roemer, Frank; Kwoh, C. Kent; Hayashi, Daichi; Felson, David T.; Guermazi, Ali (Nature Reviews Rheumatology, 2018)
Currently, no disease-modifying osteoarthritis drugs (DMOADs) have been approved. Past clinical trials have failed for several reasons, including the commonly applied definition of eligibility based on radiographic assessment of joint structure. In the context of precision medicine, finding the appropriate patient for a specific treatment approach will be of increasing relevance. Phenotypic stratification by use of imaging at the time of determining eligibility for clinical trials will be paramount and cannot be achieved using radiography alone. Furthermore, identification of joints at high risk of rapid progression of osteoarthritis is needed in order to enable a more efficient DMOAD trial design. In addition, joints at high risk of collapse need to be excluded at screening. The use of MRI might offer advantages over radiography in this context. Technological advances and simplified image assessment address many of the commonly perceived barriers to the application of MRI to assessment of eligibility for DMOAD clinical trials.
EVALuna2:35378

The Role of Speed and Possible Implications - Roemer, Frank (Radiology, 2023)
CRIS-Team Scopus Importer:2023-04-21

THE SGLT2 INHIBITOR EMPAGLIFLOZIN REDUCES TISSUE SODIUM CONTENT IN PATIENTS WITH CHRONIC HEART FAILURE - Kolwelter, Julie; Kannenkeril, Dennis; Linz, Peter; Jung, Susanne; Nagel, Armin Michael; Bosch, Agnes; Ott, Christian; Bramlage, Peter; Uder, Michael; Achenbach, Stephan; Schmieder, Roland (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2021)
CRIS-Team WoS Importer:2021-06-04

The SGLT2 inhibitor empagliflozin reduces tissue sodium content in patients with chronic heart failure: results from a placebo-controlled randomised trial - Kolwelter, Julie; Kannenkeril, Dennis; Linz, Peter; Jung, Susanne; Nagel, Armin Michael; Bosch, Agnes; Ott, Christian; Bramlage, Peter; Nöh, Lisa; Schiffer, Mario; Uder, Michael; Achenbach, Stephan; et al. (Clinical Research in Cardiology, 2022)
Introduction: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have cardiovascular protective properties in addition to the metabolic effects and represent a cornerstone of treating patients with chronic heart failure (CHF). We hypothesised that empagliflozin reduces tissue sodium content in patients with CHF. Methods: In a double-blind, randomised (2:1), placebo-controlled, parallel-group, clinical trial, 74 patients with NYHA class II–III CHF and an ejection fraction of 49% or less received empagliflozin 10 mg once daily or placebo for 3 months. In each patient, tissue sodium content of the lower leg was assessed non-invasively by sodium-MRI (23Na-MRI) at baseline, after 1 and 3 months of treatment. Results: After 1 and 3 months treatment with empagliflozin (n = 48), a significant decrease in skin sodium content was observed (1 month: 22.8 ± 6.1 vs. 21.6 ± 6.0 AU, p = 0.039; 3 months: 22.9 ± 6.1 vs. 21.6 ± 6.1 AU, p = 0.013), while there was no change in muscle sodium and muscle water content. In direct comparison, the change in skin sodium content between baseline and 3 months was − 1.3 ± 3.5 AU in the empagliflozin group versus 0.6 ± 3.5 AU in the placebo group (p for between-group difference = 0.022). No significant difference regarding change in muscle sodium and in muscle water content was observed after 3 months treatment between the two groups. Conclusion: This trial showed a significant decrease in skin sodium content after 1 and 3 months of treatment with empagliflozin. The decrease in skin sodium content may reflect a decrease in subclinical micro-oedema or/and in non-osmotic bound tissue sodium, both reported to impair left ventricular function. Trial registration number: NCT03128528 (http://www.clinicaltrials.gov). Trial registration date: 25th April 2017.
CRIS-Team Scopus Importer:2022-11-04
Keywords: Chronic heart failure; Empagliflozin; Magnetic resonance imaging; SGLT2 inhibitor; Sodium; Tissue sodium content

The soluble CD83 protein prevents bone destruction by inhibiting the formation of osteoclasts and inducing resolution of inflammation in arthritis - Royzman, Dmytro; Andreev, Darja; Stich, Lena; Peckert, Katrin; Wild, Andreas; Zinser, Elisabeth; Mühl-Zürbes, Petra; Jones, Evan; Adam, Susanne; Frey, Silke; Fuchs, Maximilian; Kunz, Meik; et al. (Frontiers in Immunology, 2022)
Here we show that soluble CD83 induces the resolution of inflammation in an antigen-induced arthritis (AIA) model. Joint swelling and the arthritis-related expression levels of IL-1 beta, IL-6, RANKL, MMP9, and OC-Stamp were strongly reduced, while Foxp3 was induced. In addition, we observed a significant inhibition of TRAP(+) osteoclast formation, correlating with the reduced arthritic disease score. In contrast, cell-specific deletion of CD83 in human and murine precursor cells resulted in an enhanced formation of mature osteoclasts. RNA sequencing analyses, comparing sCD83- with mock treated cells, revealed a strong downregulation of osteoclastogenic factors, such as Oc-Stamp, Mmp9 and Nfatc1, Ctsk, and Trap. Concomitantly, transcripts typical for pro-resolving macrophages, e.g., Mrc1/2, Marco, Klf4, and Mertk, were upregulated. Interestingly, members of the metallothionein (MT) family, which have been associated with a reduced arthritic disease severity, were also highly induced by sCD83 in samples derived from RA patients. Finally, we elucidated the sCD83-induced signaling cascade downstream to its binding to the Toll-like receptor 4/(TLR4/MD2) receptor complex using CRISPR/Cas9-induced knockdowns of TLR4/MyD88/TRIF and MTs, revealing that sCD83 acts via the TRIF-signaling cascade. In conclusion, sCD83 represents a promising therapeutic approach to induce the resolution of inflammation and to prevent bone erosion in autoimmune arthritis.
CRIS-Team WoS Importer:2022-09-09

The structural basis of MRI bone erosions: An assessment by microCT - Albrecht, Andreas; Finzel, Stephanie; Englbrecht, Matthias; Rech, Jürgen; Hueber, Axel; Schlechtweg, Philipp; Uder, Michael; Schett, Georg (Annals of the Rheumatic Diseases, 2013)
Objective To determine whether erosions appearing in MRI in patients with rheumatoid arthritis (RA) represent true erosions. Methods 50 RA patients received 1.5 T MRI and microCT (μCT) of the dominant hand. Erosion counts were assessed in coronal T1 weighted MRI sections and in coronal as well as axial μCT sections of the metacarpophalangeal (MCP) joints II-IV. Extent of erosions was assessed by RA MRI Score (RAMRIS) erosion score (MRI) and by three-dimensional assessment of erosion volume (μCT). Results 111 of the 600 evaluated joint regions showed erosions in the MRI and 137 in the μCT. In only 28 regions false negative lesions (μCT positive, MRI negative) were found, all of which were very small lesions with a volume of less than 10 mm3. Only two results were false-positive (μCT negative, MRI positive). RAMRIS erosion scores were strongly correlated to erosion volumes in the μCT (Pearson's r=0.514, p<0.001). Mean RAMRIS erosion scores were below 1 with erosion volumes up to 1.5 mm3, below 2 with erosion volumes up to 20 mm3 and over 2 with volumes of more than 20 mm3. Discussion MRI erosions are generally based on true cortical breaks as shown by μCT. MRI is sensitive to detect bone erosions and only very small lesions escape detection. Moreover, RAMRIS erosion scores are closely linked to the absolute size of bone erosions in the μCT.
CRIS-Team Scopus Importer:2021-02-03

The third dimension in perforator mapping—Comparison of Cinematic Rendering and maximum intensity projection in abdominal-based autologous breast reconstruction - Hauck, Theresa; Arkudas, Andreas; Horch, Raymund E.; Ströbel, Armin; May, Matthias; Binder, Johannes; Krautz, Christian; Ludolph, Ingo (Journal of Plastic Reconstructive and Aesthetic Surgery, 2022)
Background: Cinematic Rendering (CR) is a recently introduced post-processing three-dimensional (3D) visualization imaging tool. The aim of this study was to assess its clinical value in the preoperative planning of deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, and to compare it with maximum intensity projection (MIP) images. The study presents the first application of CR for perforator mapping prior to autologous breast reconstruction. Methods: Two senior surgeons independently analyzed CR and MIP images based on computed tomography angiography (CTA) datasets of 20 patients in terms of vascular pedicle characteristics, the possibility to harvest a DIEP or MS-TRAM flap, and the side of the flap harvest. We calculated inter- and intra-observer agreement in order to examine the accordance of both image techniques. Results: We observed a good inter- and intra-observer agreement concerning the type of flap and the side of the flap harvest. However, the agreement on the pedicle characteristics varies depending on the considered variable. Both investigators identified a significantly higher number of perforators with MIP compared with CR (observer 1, p<0.0001 and observer 2, p<0.0385). Conclusion: The current study serves as an explorative study, showing first experiences with CR in abdominal-based autologous breast reconstruction. In addition to MIP images, CR might improve the surgeon's understanding of the individual's anatomy. Future studies are required to compare CR with other 3D visualization tools and its possible effects on operative parameters.
CRIS-Team Scopus Importer:2022-03-11
Keywords: 3D visualization; Computed tomography angiography; DIEP; MS-TRAM

The traveling heads 2.0: Multicenter reproducibility of quantitative imaging methods at 7 Tesla - Voelker, Maximilian N.; Kraff, Oliver; Goerke, Steffen; Laun, Frederik Bernd; Hanspach, Jannis; Pine, Kerrin J.; Ehses, Philipp; Zaiß, Moritz; Liebert, Andrzej; Straub, Sina; Eckstein, Korbinian; Robinson, Simon; et al. (NeuroImage, 2021)
Object: This study evaluates inter-site and intra-site reproducibility at ten different 7 T sites for quantitative brain imaging. Material and Methods: Two subjects – termed the “traveling heads” – were imaged at ten different 7 T sites with a harmonized quantitative brain MR imaging protocol. In conjunction with the system calibration, MP2RAGE, QSM, CEST and multi-parametric mapping/relaxometry were examined. Results: Quantitative measurements with MP2RAGE showed very high reproducibility across sites and subjects, and errors were in concordance with previous results and other field strengths. QSM had high inter-site reproducibility for relevant subcortical volumes. CEST imaging revealed systematic differences between the sites, but reproducibility was comparable to results in the literature. Relaxometry had also very high agreement between sites, but due to the high sensitivity, differences caused by different applications of the B1 calibration of the two RF coil types used were observed. Conclusion: Our results show that quantitative brain imaging can be performed with high reproducibility at 7 T and with similar reliability as found at 3 T for multicenter studies of the supratentorial brain.
CRIS-Team Scopus Importer:2021-03-19
Keywords: Magnetic resonance imaging; Multicenter; Quantitative imaging; Reproducibility; Ultrahigh field

The value of “constant sharpness” as a diagnostic sign in MR-Mammography - Kaiser, Clemens G.; Baltzer, Pascal; Kaiser, Anna K.; Krammer, Julia; Uder, Michael; Kaiser, Werner A.; Dietzel, Matthias (European Journal of Radiology Open, 2016)
Purpose To examine “constant lesion sharpness” as a morphological diagnostic sign in the differential diagnosis between benign and malignant lesions. Material and methods This prospective study had institutional review board approval and was HIPAA compliant. In total 1014 consecutive patients were examined (mean age 55 years ± 13 years) and evaluated in our University hospital towards the morphological shape of the lesion borders. The “Constant sharpness Sign” was defined as a lesion remaining continuously sharp for the duration of the dynamic scan. Inclusion criteria were unclear findings (e.g. BIRADS III/IV), Preoperative staging (BRIDAS IV/V), and referred patients from local clinic of gynecology. Exclusion criteria were MRM-examination ≤1 year before, status after surgery and/or biopsy, chemotherapy and/or radiation therapy. Reference Standard was histological verification. Images were diagnosed by two experienced radiologists in consensus, blinded to the standard of reference. Results 1014 patients with 1084 lesions (436 benign, 648 malignant lesions) were included into the study. 41.5% of benign lesions and 6.8% (181/436) of malignant lesions displayed a constant sharpness as an accompanying morphological sign (P < 0.001). This resulted in a sensitivity of 41.5%, specificity of 93.2%, a positive likelihood ratio of 6.1%, a negative likelihood ratio of 0.63 and an odd's ratio of 9,7%. Summary and conclusion The constant sharpness sign seems to be an accurate predictor of benign breast lesions, which may help to increase the accuracy of MRM as a morphological sign.
CRIS-Team Scopus Importer:2023-03-08
Keywords: Breast-MR; Constant sharpness; Morphology; MR-Mammography

The Value of syngo DynaPBV Neuro During Neuro-Interventional Hypotensive Balloon Occlusion Test - Yang, M.; Wu, J.; Ma, L.; Pan, L.; Li, J.; Chen, G.; Struffert, Tobias; Sun, Q.; Beilner, J.; Deuerling-Zheng, Y. (Clinical Neuroradiology, 2015)
This study explored the value of flat detector computed tomography based brain perfusion imaging in assessing patient's tolerance prior to the permanent internal carotid artery occlusion.Ten patients diagnosed with neurovascular diseases through digital subtracted angiography (DSA) were enrolled into this study. Temporary balloon occlusion test (BOT) was performed for each patient with hypotensive challenge. During the test, parametric color-coded quantitative DSA (CCQ-DSA) was generated to evaluate the venous filling symmetry on both hemispheres. In addition, cerebral blood volume (CBV) maps were acquired before and during the test. Regions of interests were defined to quantitatively extract CBV value from affected and unaffected hemispheres and calculate relative CBV (rCBV), indicating perfusion symmetry.All the patients showed good perfusion symmetry before the test with rCBV close to 1.00. During the test, good perfusion symmetry was detected in 7 patients with averaged rCBV 1.03 ± 0.06. Only short venous delay and no ischemic complications were recognized. One patient had neither neurologic deficits nor long venous delay detected, however, showed hyper-perfusion in specific regions in the CBV maps. Two patients failed to pass the test, which showed significantly low CBV value from the affected hemisphere with maximum rCBV reduction close to 45 %.CBV map had in general good consistency with clinical manifestations as well as venous filling in the BOT. Besides, it may provide further evidence of hemodynamic variations and delayed ischemic complications, and thus, had a potential to reduce risks and increase treatment safety.
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The View of clinical Application New Study on 7 Tesla-MRI of the Wrist - Weber, Marc-Andre; Roemer, Frank (Radiologe, 2018)
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The View of clinical Application New Study on 7-Tesla MRI of the Wrist - Weber, M. -A.; Roemer, Frank (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2018)
EVALuna2:36240

Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction - Rompel, Oliver; Glöckler, Martin; Janka, Rolf Matthias; Dittrich, Sven; Cesnjevar, Robert; Lell, Michael; Uder, Michael; Hammon, Matthias (Pediatric Radiology, 2016)
Many technical updates have been made in multi-detector CT.To evaluate image quality and radiation dose of high-pitch second- and third-generation dual-source chest CT angiography and to assess the effects of different levels of advanced modeled iterative reconstruction (ADMIRE) in newborns and children.Chest CT angiography (70 kVp) was performed in 42 children (age 158 ± 267 days, range 1-1,194 days). We evaluated subjective and objective image quality, and radiation dose with filtered back projection (FBP) and different strength levels of ADMIRE. For comparison were 42 matched controls examined with a second-generation 128-slice dual-source CT-scanner (80 kVp).ADMIRE demonstrated improved objective and subjective image quality (P < .01). Mean signal/noise, contrast/noise and subjective image quality were 11.9, 10.0 and 1.9, respectively, for the 80 kVp mode and 11.2, 10.0 and 1.9 for the 70 kVp mode. With ADMIRE, the corresponding values for the 70 kVp mode were 13.7, 12.1 and 1.4 at strength level 2 and 17.6, 15.6 and 1.2 at strength level 4. Mean CTDIvol, DLP and effective dose were significantly lower with the 70-kVp mode (0.31 mGy, 5.33 mGy*cm, 0.36 mSv) compared to the 80-kVp mode (0.46 mGy, 9.17 mGy*cm, 0.62 mSv; P < .01).The third-generation dual-source CT at 70 kVp provided good objective and subjective image quality at lower radiation exposure. ADMIRE improved objective and subjective image quality.
EVALuna2:14476

Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics - Hayashi, Daichi; Roemer, Frank; Kohler, Ryan; Guermazi, Ali; Gebers, Chris; De Villiers, Richard (British Journal of Sports Medicine, 2014)
Professional rugby players are prone to traumatic thoracic injuries due to the use of minimal protective gear to cover the torso. In the 2007 Rugby World Cup, thoracic injuries occurred at a rate of 8.3 cases/1000 player-hours. CT and MRI play an important role in the diagnosis of these injuries. Vital internal organs, such as the heart, lungs, trachea, liver and large blood vessels lie within close proximity to the bony structures and what seems to be a simple rib fracture or clavicular dislocation can have potentially life-threatening complications that are not detected by conventional radiography. Cross-sectional imaging helps to determine the choice of treatment. Ultrasound offers a quick and dynamic imaging examination and allows high-resolution assessment of superficial tissues that complements conventional imaging. In this review article, we (1) presented data on incidence of thoracic injuries in professional rugby players; (2) described the anatomy of the joints comprising the thoracic cage and major muscles attached to the rib cage; (3) discussed indications and relevance for MRI and presented an optimised MRI protocol for assessment of suspected thoracic injury; and (4) illustrated various types of thoracic injuries seen in professional rugby players, including sternal contusion, retrosternal haematoma, manubriosternal disruption, sternoclavicular dislocation, rib fractures and injuries of the pectoralis major muscle.
EVALuna2:14395

Thoracic non-osseous lesions in cancer patients detected in low-dose CT images acquired as part of skeletal SPECT/CT examinations - Wüst, Wolfgang; Lell, Michael; May, Matthias; Saake, Marc; Kuwert, Torsten; Uder, Michael; Linke, Rainer (Nuklearmedizin-Nuclear Medicine, 2015)
Hybrid single-photon emission tomographic (SPECT) and X-ray computed tomography (CT) systems are increasingly used in oncologic imaging. With SPECT/CT not only the thoracic spine but also the surrounding soft tissue needs to be evaluated for pathological findings. The purpose of this study was to assess the prevalence of non-osseous findings detectable on low-dose CT datasets from patients studied by thoracic 99mTc-dicarboxypropane diphosphonate (DPD)-SPECT/CT.119 consecutive oncologic patients (81 breast cancer, 38 with other cancer) who underwent DPD-SPECT CT of the thoracic region were included in this study. Non-osseous findings on CT were classified as either probably benign or suspicious. Suspicious findings were correlated with retrievable previous imaging and if performed with follow up imaging (MRI, CT with contrast medium, Ultrasound) or biopsy results.In 80/119 (67%) patients no imaging was performed before SPECT/CT. Only 7/119 subjects (6%) had no other lesions than bone lesions. In 101/119 (85%) patients lesions found on SPECT/CT images were rated as benign and in 65/119 (55%) patients as suspicious. In 8/119 (7%) patients with previously unknown suspicious lesions on SPECT/CT images suspicious findings were confirmed by biopsy.7% of patients referred to SPECT/CT of the thoracic spine for staging of malignant disease had previously unknown suspicious non-osseous lesions detectable on the low-dose CT images which were confirmed by biopsy. This could be especially relevant for cancer entities like breast and prostate, in which no thorax-CT is routinely intended for staging.
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